Article

OBJECTIVE: To examine the accuracy of clinical tests for diagnosing subacromial
impingement syndrome (SIS).
A systematic literature search was conducted in January 2011 to identify all studies that examined the diagnostic
accuracy of clinical tests for SIS. The following search engines were used:
Cochrane Library, EMBASE, Science Direct, and PubMed. STUDY SELECTION: Two
reviewers screened all articles. We included prospective or retrospective cohort
studies that examined individuals with a painful shoulder, reported any clinical
test for SIS, and used arthroscopy or open surgery as the reference standard. The
search strategy yielded 1338 articles of which 1307 publications were excluded
based on title/abstract. Sixteen of the remaining 31 articles were included. The
PRISMA (preferred reporting items for systematic reviews and meta-analyses)
guidelines were followed to conduct this review. DATA EXTRACTION: The number of
true positives, false positives, true negatives, and false negatives for each
clinical test were extracted from relevant studies, and a 2x2 table was
constructed. Studies were combined using a bivariate random-effects model.
Heterogeneity was assessed using the variance of logit-transformed sensitivity
and specificity. DATA SYNTHESIS: Ten studies with 1684 patients are included in
the meta-analysis. The Hawkins-Kennedy test, Neer's sign, and empty can test are
shown to be more useful for ruling out rather than ruling in SIS, with greater
pooled sensitivity estimates (range, .69-.78) than specificity (range, .57-.62).
A negative Neer's sign reduces the probability of SIS from 45% to 14%. The drop
arm test and lift-off test have higher pooled specificities (range, .92-.97) than
sensitivities (range, .21-.42), indicating that they are more useful for ruling
in SIS if the test is positive. CONCLUSIONS: This systematic review quantifies
the diagnostic accuracy of 5 clinical tests for SIS, in particular the lift-off
test. Accurate diagnosis of SIS in clinical practice may serve to improve
appropriate treatment and management of individuals with shoulder complaints.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS