Diagnostic Accuracy Of The Clinical Examination For Labral Tears Of The Shoulder
MIchener LA, Walsworth MK, Murphy K, Bimson W, Mielcarek BJ, Doukas W

Purpose:  The purpose of this study was to examine the diagnostic accuracy of the commonly used clinical tests for labral tears.

Subjects:  Patients (n-55) ages 18-83 (mean=41) with unresolving shoulder pain of 2 months to 20 years duration (mean=33 months) were included.

Methods:  Patients were examined using four tests: 1.  subjective complaint of clicking, popping, or catching (CLICK), 2. active compression (AC), 3. anterior slide (AS) and 4. crank.  Surgical findings were used as the gold standard for diagnosis of labral tear.

Results: The combination of a subjective click and all three positive tests yielded a specificity of 100% and sensitivity of 16% and a positive likelihood ratio of 6.5 (.25-65.00=95% CI).  The presence of a click or any single positive test yielded a sensitivity of 93% and specificity of 0% and a negative likelihood ratio of 2.80 (.10-.34.0=95%CI).  Single tests demonstrated sensitivity and specificity, respectively, as follows: crank (55%, 55%), AC (59%, 36%), AS 57%, 64%) and CLICK (52%, 64%). 

Conclusions/Clinical Relevance:  The sensitivity and specificity results suggest that using a combination of clinical tests may be more useful than individual tests when considering a diagnosis of labral tear.  Negative findings on the combination of tests may help to rule out the diagnosis, while positive findings on the combination of tests may help to rule in the diagnosis.  However, despite high sensitivity and specificity values for the test combinations, these findings did not provide a significant shift in post-test probability due to the high prevalence of labral tears in the sample population.