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CC BY 4.0 · Surg J (N Y) 2017; 03(02): e79-e87
DOI: 10.1055/s-0037-1601878
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Diagnostic Validity of Patient-Reported History for Shoulder Pathology

Lyndsay E. Somerville
1   Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
,
Kevin Willits
1   Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
,
Andrew M. Johnson
2   School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
,
Robert Litchfield
1   Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
,
Marie-Eve LeBel
1   Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
,
Jaydeep Moro
3   Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
,
Dianne Bryant
1   Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
2   School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
4   Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
› Author Affiliations
Further Information

Publication History

10 June 2016

28 February 2017

Publication Date:
24 April 2017 (online)

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Abstract

Objective The purpose of this article is to determine whether patient-reported history items are predictive of shoulder pathology and have the potential for use in triaging patients with shoulder pathology to orthopaedic outpatient clinics.

Setting It is set at two tertiary orthopaedic clinics.

Patients All new patients reporting pain and/or disability of the shoulder joint were prospectively recruited. A total of 193 patients were enrolled, 15 of whom withdrew, leaving 178 patients composing the study sample.

Design Patients completed a questionnaire on the history of their pathology, then the surgeon took a thorough history indicating the most likely diagnosis. The clinician then performed appropriate physical examination. Arthroscopy was the reference standard for those undergoing surgery and magnetic resonance imaging (MRI) with arthrogram for all others. We calculated the sensitivity, specificity, and likelihood ratios (LRs) of history items alone and in combination. We used the LRs to generate a clinical decision algorithm.

Main Outcome Measures Diagnosis was determined through arthroscopy or MRI arthrogram. Reporting was standardized to ensure review of all structures.

Results The physical examination and history agreed in 75% of cases. Of those that did not agree, the physical examination misdirected the diagnosis in 47% of our cases. In particular, history items were strong predictors of anterior and posterior instability and subscapularis tears and were combined in a tool to be utilized for screening patients.

Conclusion The patient-reported history items were effective for diagnosing shoulder pathology and should be considered for use in a triaging instrument.

Keywords

shoulder - diagnosis - history
 

  • References

  • 1 Canadian Institutes of Health Research. Musculoskeletal Health and Arthritis: Strategic Plan 2014–2018. April 6, 2017
    PubMed
  • 2 Stevenson JH, Trojian T. Evaluation of shoulder pain. J Fam Pract 2002; 51 (07) 605-611
    PubMedGoogle Scholar
  • 3 Platt R. Two essays on the practice of medicine. Lancet 1947; 2 (6470): 305-307
    PubMedGoogle Scholar
  • 4 Hampton JR, Harrison MJ, Mitchell JR, Prichard JS, Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. BMJ 1975; 2 (5969): 486-489
    CrossrefPubMedGoogle Scholar
  • 5 Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med 1992; 156 (02) 163-165
    PubMedGoogle Scholar
  • 6 Litaker D, Pioro M, El Bilbeisi H, Brems J. Returning to the bedside: using the history and physical examination to identify rotator cuff tears. J Am Geriatr Soc 2000; 48 (12) 1633-1637
    CrossrefPubMedGoogle Scholar
  • 7 Holtby R, Razmjou H. Validity of the supraspinatus test as a single clinical test in diagnosing patients with rotator cuff pathology. J Orthop Sports Phys Ther 2004; 34 (04) 194-200
    CrossrefPubMedGoogle Scholar
  • 8 Michener LA, Doukas WC, Murphy KP, Walsworth MK. Diagnostic accuracy of history and physical examination of superior labrum anterior-posterior lesions. J Athl Train 2011; 46 (04) 343-348
    CrossrefPubMedGoogle Scholar
  • 9 Speed CA, Crisp AJ. Referrals to hospital-based rheumatology and orthopaedic services: seeking direction. Rheumatology (Oxford) 2005; 44 (04) 469-471
    CrossrefPubMedGoogle Scholar
  • 10 Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med 1992; 21 (04) 384-390
    CrossrefPubMedGoogle Scholar
  • 11 Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003; 326 (7386): 417
    CrossrefPubMedGoogle Scholar
  • 12 Stiell I, Wells G, Laupacis A. , et al; Multicentre Ankle Rule Study Group. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. BMJ 1995; 311 (7005): 594-597
    CrossrefPubMedGoogle Scholar
  • 13 Somerville LE, Willits K, Johnson AM. , et al. Clinical assessment of physical examination maneuvers for rotator cuff lesions. Am J Sports Med 2014; 42 (08) 1911-1919
    CrossrefPubMedGoogle Scholar
  • 14 Somerville LE. Diagnostic validity of physical examination and history for shoulder pathology. Electronic Thesis and Dissertation Repository. Western Graduate and PostDoctoral Studies; 2012
    Google Scholar
  • 15 Garneau RA, Renfrew DL, Moore TE, el-Khoury GY, Nepola JV, Lemke JH. Glenoid labrum: evaluation with MR imaging. Radiology 1991; 179 (02) 519-522
    CrossrefPubMedGoogle Scholar
  • 16 Legan JM, Burkhard TK, Goff II WB. , et al. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology 1991; 179 (01) 241-246
    CrossrefPubMedGoogle Scholar
  • 17 Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR. Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elbow Surg 2006; 15 (05) 580-585
    CrossrefPubMedGoogle Scholar
  • 18 Torstensen ET, Hollinshead RM. Comparison of magnetic resonance imaging and arthroscopy in the evaluation of shoulder pathology. J Shoulder Elbow Surg 1999; 8 (01) 42-45
    CrossrefPubMedGoogle Scholar
  • 19 Tung GA, Entzian D, Green A, Brody JM. High-field and low-field MR imaging of superior glenoid labral tears and associated tendon injuries. AJR Am J Roentgenol 2000; 174 (04) 1107-1114
    CrossrefPubMedGoogle Scholar
  • 20 Applegate GR, Hewitt M, Snyder SJ, Watson E, Kwak S, Resnick D. Chronic labral tears: value of magnetic resonance arthrography in evaluating the glenoid labrum and labral-bicipital complex. Arthroscopy 2004; 20 (09) 959-963
    CrossrefPubMedGoogle Scholar
  • 21 Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol 2004; 182 (05) 1271-1278
    CrossrefPubMedGoogle Scholar
  • 22 de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 2009; 192 (06) 1701-1707
    CrossrefPubMedGoogle Scholar
  • 23 Glazier RH, Dalby DM, Badley EM. , et al. Management of common musculoskeletal problems: a survey of Ontario primary care physicians. CMAJ 1998; 158 (08) 1037-1040
    PubMedGoogle Scholar
  • 24 Menzies RD, Young RA. Referrals from a primary care-based sports medicine department to an orthopaedic department: a retrospective cohort study. Br J Sports Med 2011; 45 (13) 1064-1067
    CrossrefPubMedGoogle Scholar
  • 25 Roland MO, Porter RW, Matthews JG, Redden JF, Simonds GW, Bewley B. Improving care: a study of orthopaedic outpatient referrals. BMJ 1991; 302 (6785): 1124-1128
    CrossrefPubMedGoogle Scholar
  • 26 Matheny JM, Brinker MR, Elliott MN, Blake R, Rowane MP. Confidence of graduating family practice residents in their management of musculoskeletal conditions. Am J Orthop 2000; 29 (12) 945-952
    PubMedGoogle Scholar
  • 27 Dong SL, Bullard MJ, Meurer DP. , et al. Emergency triage: comparing a novel computer triage program with standard triage. Acad Emerg Med 2005; 12 (06) 502-507
    CrossrefPubMedGoogle Scholar