Diagnostic Accuracy of Clinical Tests in Detecting Rotator Cuff Pathology

Purpose: There is minimal information on predictive value of strength-related clinical tests in detecting rotator cuff (RC) tear size and tendon reparability of large and massive tears. The purpose of this diagnostic study was to examine the validity of four strength-related clinical sign/tests in relation to RC tear size and reparability. Methods: This was a prospective blinded study of consecutive patients with a full thickness RC tear who underwent a repair. The magnetic resonance imaging (MRI) and arthroscopic surgery were used as the gold standards. Results: Eighty-five patients, 50 males (59%), age 65, SD=10 completed the study. There were 60 (71%) minor tears (small/ moderate) and 25 (29%) major tears (large/massive) with 70 (82%) patients achieving a full repair. The Jobe test had a sensitivity of 93% and 88% and a negative likelihood ratio (LR) of 0.16 and 0.27 for tendon reparability and tear size respectively. The dropping sign, hornblower sign and lift-off test had poor sensitivity (<60%) and high specificity (>98%) values with large positive LRs for tear size detection and tendon reparability. The validity indices in relation to MRI findings were similar to surgical findings. Conclusion: A negative Jobe test accurately ruled out the presence of a major tear, significant supraspinatus fatty infiltration and a need for partial repair. The dropping and hornblower signs and lift off test were highly specific and when positive, they confirmed the presence of a major tear, fatty infiltration in the corresponding muscle and difficulty achieving a full repair.