scholarly journals Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions

2017 ◽  
Vol 03 (04) ◽  
pp. e154-e162 ◽  
Author(s):  
Lyndsay Somerville ◽  
Kevin Willits ◽  
Andrew Johnson ◽  
Robert Litchfield ◽  
Marie-Eve LeBel ◽  
...  
Keyword(s):  
Physical Examination ◽  
Slap Lesion ◽  
Measurement Properties ◽  
Likelihood Ratios ◽  
Diagnostic Challenge ◽  
Slap Lesions ◽  
Arthroscopic Examination ◽  
Physical Tests ◽  
Sensitivity Specificity ◽  
Slap Tear

Purpose Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study. Methods We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis (“certain the diagnosis is absent/present,” or “uncertain requires further testing”). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions. Results Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I–V) as disease positive, none of the tests was sensitive (10.3–33.3) although they were moderately specific (61.3–92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5–38.7) and specificity (70.6–93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and specificity 64.7%). Conclusion Our study demonstrates that the physical examination tests for SLAP lesions are poor diagnostic indicators of disease. Performing a combination of tests will likely help, although the magnitude of the improvement is minimal. These authors caution clinicians placing confidence in the physical examination tests for SLAP lesions rather we suggest that clinicians rely on diagnostic imaging to confirm this diagnosis.

scholarly journals Diagnostic performance of 3D-multi-Echo-data-image-combination (MEDIC) for evaluating SLAP lesions of the shoulder

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Felix Wuennemann ◽  
Laurent Kintzelé ◽  
Felix Zeifang ◽  
Michael W. Maier ◽  
Iris Burkholder ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Predictive Value ◽  
Gold Standard ◽  
Proton Density ◽  
Diagnostic Challenge ◽  
Cohen’S Kappa ◽  
Slap Lesions ◽  
Cohen's Kappa ◽  
Sensitivity Specificity ◽  
Interreader Agreement

Abstract Background Superior labral anterior to posterior (SLAP) lesions remain a clinical and diagnostic challenge in routine (non-arthrographic) MR examinations of the shoulder. This study prospectively evaluated the ability of 3D-Multi-Echo-Data-Image-Combination (MEDIC) compared to that of routine high resolution 2D-proton-density weighted fat-saturated (PD fs) sequence using 3 T-MRI to detect SLAP lesions using arthroscopy as gold standard. Methods Seventeen consecutive patients (mean age, 51.6 ± 14.8 years, 11 males) with shoulder pain underwent 3 T MRI including 3D-MEDIC and 2D-PD fs followed by arthroscopy. The presence or absence of SLAP lesions was evaluated using both sequences by two independent raters with 4 and 14 years of experience in musculoskeletal MRI, respectively. During arthroscopy, SLAP lesions were classified according to Snyder’s criteria by two certified orthopedic shoulder surgeons. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 3D-MEDIC and 2D-PD fs for detection of SLAP lesions were calculated with reference to arthroscopy as a gold standard. Interreader agreement and sequence correlation were analyzed using Cohen’s kappa coefficient. Figure 1 demonstrates the excellent visibility of a proven SLAP lesion using the 3D-MEDIC and Fig. 2 demonstrates a false-positive case. Results Arthroscopy revealed SLAP lesions in 11/17 patients. Using 3D-MEDIC, SLAP lesions were diagnosed in 14/17 patients by reader 1 and in 13/17 patients by reader 2. Using 2D-PD fs, SLAP lesions were diagnosed in 11/17 patients by reader 1 and 12/17 patients for reader 2. Sensitivity, specificity, PPV, and NPV of 3D-MEDIC were 100.0, 50.0, 78.6, and 100.0% for reader 1; and 100.0, 66.7, 84.6, and 100% for reader 2, respectively. Sensitivity, specificity, PPV, and NPV of 2D-PD fs were 90.9, 83.3, 90.9, and 83.3% for reader 1 and 100.0, 83.3, 91.7, and 100.0% for reader 2. The combination of 2D-PD fs and 3D-MEDIC increased specificity from 50.0 to 83.3% for reader 1 and from 66.7 to 100.0% for reader 2. Interreader agreement was almost perfect with a Cohen’s kappa of 0.82 for 3D-MEDIC and 0.87 for PD fs. Conclusions With its high sensitivity and NPV, 3D-MEDIC is a valuable tool for the evaluation of SLAP lesions. As the combination with routine 2D-PD fs further increases specificity, we recommend incorporation of 3D-MEDIC as an additional sequence in conventional shoulder protocols in patients with non-specific shoulder pain.

Physical Examination for Partial Tears of the Biceps Tendon

2007 ◽  
Vol 35 (8) ◽  
pp. 1334-1340 ◽  
Author(s):  
Harpreet S. Gill ◽  
George El Rassi ◽  
Michael S. Bahk ◽  
Renan C. Castillo ◽  
Edward G. McFarland
Keyword(s):  
Rotator Cuff ◽  
Positive Predictive Value ◽  
Physical Examination ◽  
Predictive Value ◽  
Biceps Tendon ◽  
Likelihood Ratios ◽  
Partial Tears ◽  
Long Head ◽  
Sensitivity Specificity ◽  
Arthroscopic Procedures

Background The accuracy of the physical examination for tears of the long head of the biceps remains controversial. Purpose The goals were 1) to characterize the occurrence of partial tears of the long head of the biceps tendon in a group of consecutive patients, and 2) to analyze the diagnostic value of various clinical tests for pathologic lesions of the proximal biceps tendon. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Of 847 consecutive patients who underwent arthroscopic procedures for a variety of shoulder conditions, 40 were found at the time of arthroscopy to have partial biceps tendon tears. The average age of these 24 men and 16 women was 59 years (range, 18-83). Preoperative physical examinations had included 9 commonly used tests for shoulder examination. Statistical analysis included sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios for these tests. Results The prevalence rate of partial tears was 5% (40/847) of all arthroscopic procedures. The most commonly associated conditions included rotator cuff tears (85% [34/40]) and anterior instability (7.5% [3/40]). Tenderness on palpation of the long head of the biceps tendon had a sensitivity of 53%, a specificity of 54%, and a likelihood ratio of 1.13. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios for Speed's test were 50%, 67%, 8%, 96%, and 1.51, respectively. Conclusion In patients with rotator cuff abnormality, the diagnosis of partial biceps tears cannot be made reliably with existing physical examination tests. Diagnostic arthroscopy is recommended, if clinically indicated, for potential partial tears of the long head of the biceps tendon. The treating physician should be prepared to treat unsuspected tears of the long head of the biceps tendon at the time of surgery.

scholarly journals SLAP lesions: current controversies

2019 ◽  
Vol 4 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Filippo Familiari ◽  
Gazi Huri ◽  
Roberto Simonetta ◽  
Edward G. McFarland
Keyword(s):  
Surgical Treatment ◽  
Physical Examination ◽  
Clinical Presentation ◽  
Patient Characteristics ◽  
Diagnostic Value ◽  
Shoulder Injuries ◽  
Biceps Tenodesis ◽  
Glenoid Labrum ◽  
Slap Lesions ◽  
Slap Tear

Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear. Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons. First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous. Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries. Third, SLAP lesions have no specific associated pain pattern. Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics. Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.

Performance of physical examination versus ultrasonography to detect stenosis in haemodialysis arteriovenous fistula

2016 ◽  
Vol 18 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Ana B. Maldonado-Cárceles ◽  
José García-Medina ◽  
Alberto M. Torres-Cantero
Keyword(s):  
Physical Examination ◽  
Arteriovenous Fistula ◽  
Basic Skills ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Likelihood Ratios ◽  
Cross Sectional ◽  
Moderate Agreement ◽  
Sensitivity Specificity

Purpose The overall purpose of this study is to compare the accuracy of physical examination (PE) versus ultrasonography (US) in people with arteriovenous fistula (AVF). Methods This is a cross-sectional study with a total of 99 patients attended by the vascular radiology unit for AVF evaluation during January - March 2015. PE and ultrasonography were blinded performed by different radiologists. For complete and individual signs of PE, sensitivity, specificity, predictive positive (PPV) and negative (PNV) value, likelihood ratios (LR) and Cohen's κ value were measured. Results According to ultrasonography, the presence of stenosis was identified in 57 (58%) patients, and 61 (62%) by PE. The accuracy of PE for the diagnosis of AVF was sensitivity 82%, specificity 67%, PPV 77%, NPV 74%, LR 2.74 and 0.26. There was a moderate agreement beyond chance between PE and ultrasonography (κ = 0.5). Conclusions PE has shown a moderate accuracy to detect stenosis. With non-ultrasonography availability Haemodialysis Units can get benefit to optimize VA survival and professionals should improve its basic skills.

Clinical Assessment of the Dynamic Labral Shear Test for Superior Labrum Anterior and Posterior Lesions

2017 ◽  
Vol 45 (4) ◽  
pp. 775-781 ◽  
Author(s):  
Sonal Sodha ◽  
Uma Srikumaran ◽  
Kyubo Choi ◽  
Amrut U. Borade ◽  
Edward G. McFarland
Keyword(s):  
Predictive Value ◽  
Shear Test ◽  
Case Series ◽  
Slap Lesion ◽  
Likelihood Ratios ◽  
Level Of Evidence ◽  
Slap Lesions ◽  
Superior Labrum ◽  
Diagnostic Arthroscopy ◽  
Lift Off

Background: Diagnosing superior labrum anterior and posterior (SLAP) lesions through physical examination remains challenging. The dynamic labral shear test (DLST) has been shown to have likelihood ratios (LRs) of 31.6 and 1.1 for diagnosing SLAP lesions. Purpose: To determine the clinical utility of the DLST for diagnosing SLAP lesions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: This prospective, consecutive case series included 774 patients who underwent diagnostic arthroscopy and a preoperative DLST between 2007 and 2013. Patients were divided into 3 groups: 610 control patients with no SLAP lesion but with other abnormalities, 9 patients with isolated SLAP lesion (ISL), and 155 patients with concomitant SLAP lesion (CSL), who had a SLAP lesion and another shoulder abnormality. We determined sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), and diagnostic accuracy (DA) of the DLST with and without other tests. Results: The DLST was positive for 242 of 610 controls (40%), 7 of 9 patients (78%) in the ISL group, and 88 of 155 patients (57%) in the CSL group. In the ISL group, the DLST had a sensitivity of 78%, specificity of 51%, PPV of 2%, NPV of 100%, OR of 3.58, and DA of 51%. In comparison, the ORs were 1.09 for the active compression test, 1.30 for the lift-off test, and 1.53 for the relocation test, which were not significantly different from each other. For diagnosing a SLAP lesion existing in a joint with other associated injury, the DLST had a sensitivity of 57%, specificity of 52%, PPV of 23%, NPV of 83%, OR of 1.4, and DA of 53%. Combining all 4 tests did not improve the OR for detecting ISLs or CSLs. Conclusion: The DLST is sensitive but not specific for detecting ISLs. With an OR of 3.58, the DLST is useful for diagnosing ISLs. However, in patients who have CSLs, the DLST is not as useful for diagnosing SLAP lesions.

scholarly journals Diagnostic Validity of Patient-Reported History for Shoulder Pathology

2017 ◽  
Vol 03 (02) ◽  
pp. e79-e87 ◽  
Author(s):  
Lyndsay Somerville ◽  
Kevin Willits ◽  
Andrew Johnson ◽  
Robert Litchfield ◽  
Marie-Eve LeBel ◽  
...  
Keyword(s):  
Physical Examination ◽  
Clinical Decision ◽  
Resonance Imaging ◽  
Likelihood Ratios ◽  
Decision Algorithm ◽  
Shoulder Pathology ◽  
Patient Reported ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

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.

Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

2020 ◽  
pp. 1-15
Author(s):  
Ling-Yu Guo ◽  
Phyllis Schneider ◽  
William Harrison
Keyword(s):  
Diagnostic Accuracy ◽  
Psychometric Properties ◽  
Language Impairment ◽  
Reference Data ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Criterion Validity ◽  
Likelihood Ratios ◽  
Generation Task ◽  
Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

Comparison of Rheumatological Diagnoses by a Bayesian Program and by Physicians

1991 ◽  
Vol 30 (03) ◽  
pp. 187-193 ◽  
Author(s):  
H. J. Moens ◽  
J. K. van der Korst
Keyword(s):  
Receiver Operating Characteristics ◽  
Bayesian Decision ◽  
Operating Characteristics ◽  
Likelihood Ratios ◽  
Improve Performance ◽  
Mathematical Basis ◽  
Human Expert ◽  
Test Population ◽  
Sensitivity Specificity ◽  
Diagnostic Outcome

AbstractA Bayesian decision support system was developed for the diagnosis of rheumatic disorders. Knowledge in this system is represented as evidential weights of findings. Simple weights were calculated as the logarithm of likelihood ratios on the basis of 1,000 consecutive patients from a rheumatological clinic. The effect of various methods to improve performance of the system by modification of the weights was studied. Three methods had a mathematical basis; a fourth consisted of weights adapted by a human expert, which allowed inclusion of diagnostic rules such as defined in widely accepted criteria sets. The system’s performance was measured in a test population of 570 different cases from the same clinic and compared with predictions of diagnostic outcome made by rheumatologists. The weights from a human expert gave optimal results (sensitivity 65% and specificity 96%), that were close to the physicians’ predictions (sensitivity 64% and specificity 98%). The methods to measure the performance of the various models used in this study emphasize sensitivity, specificity and the use of receiver operating characteristics.

scholarly journals Evaluation of Cystic and Solid Renal Lesions with Contrast-Enhanced Ultrasound: A Retrospective Study

2021 ◽  
Vol 07 (01) ◽  
pp. E25-E34
Author(s):  
Arash Najafi ◽  
Michael Wildt ◽  
Nicolin Hainc ◽  
Joachim Hohmann
Keyword(s):  
Final Diagnosis ◽  
Cystic Lesions ◽  
Likelihood Ratios ◽  
Renal Lesions ◽  
Contrast Enhanced ◽  
Potentially Malignant ◽  
Sensitivity Specificity ◽  
Solid Lesions ◽  
Conclusive Diagnosis

Abstract Purpose Renal lesions are frequent random findings on CT, MRI, and conventional ultrasound. Since they are usually found accidentally, the respective examinations have not been performed optimally to provide a conclusive diagnosis, making additional multiphase contrast-enhanced examinations necessary. The aim of the study is to correlate CEUS findings with the final diagnosis and to determine whether it is a suitable method for the conclusive characterization of undetermined renal lesions. Materials and Methods All CEUS examinations of focal renal lesions performed at our institute between 2007 and 2014 were retrospectively examined. 437 patients with a total of 491 lesions and 543 examinations were included. 54 patients had bilateral lesions. One patient had three lesions in one kidney. Histology was available in 49 cases and follow-ups in 124 cases. The sensitivity, specificity, positive and negative predictive value as well as positive and negative likelihood ratios were calculated. Results There were 54 malignant and 437 benign lesions. The sensitivity and specificity were 0.981/0.954 overall, 1.000/0.956 for cystic lesions, 0.977/0.906 for solid lesions, and 0.971/0.071 for the histologically confirmed lesions. Bosniak classification was consistent in 289 of 301 lesions (96%). Only 12 lesions (3.9%) were falsely assessed as malignant. Conclusion CEUS is an appropriate method for the clarification of undetermined renal lesions. The characterization of cystic lesions according to Bosniak is adequately possible, especially for potentially malignant lesions (types III and IV).

Differentiating School-Aged Children With and Without Language Impairment Using Tense and Grammaticality Measures From a Narrative Task

2016 ◽  
Vol 59 (2) ◽  
pp. 317-329 ◽  
Author(s):  
Ling-Yu Guo ◽  
Phyllis Schneider
Keyword(s):  
Language Development ◽  
Diagnostic Accuracy ◽  
Language Impairment ◽  
Likelihood Ratios ◽  
Verb Morphology ◽  
Story Generation ◽  
School Aged Children ◽  
Sensitive Tool ◽  
Good Diagnostic Accuracy ◽  
Sensitivity Specificity

Purpose To determine the diagnostic accuracy of the finite verb morphology composite (FVMC), number of errors per C-unit (Errors/CU), and percent grammatical C-units (PGCUs) in differentiating school-aged children with language impairment (LI) and those with typical language development (TL). Method Participants were 61 six-year-olds (50 TL, 11 LI) and 67 eight-year-olds (50 TL, 17 LI). Narrative samples were collected using a story-generation format. FVMC, Errors/CU, and PGCUs were computed from the samples. Results All of the three measures showed acceptable to good diagnostic accuracy at age 6, but only PGCUs showed acceptable diagnostic accuracy at age 8 when sensitivity, specificity, and likelihood ratios were considered. Conclusion FVMC, Errors/CU, and PGCUs can all be used in combination with other tools to identify school-aged children with LI. However, FVMC and Errors/CU may be an appropriate diagnostic tool up to age 6. PGCUs, in contrast, may be a sensitive tool for identifying children with LI at least up to age 8 years.

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