A systematic review of physical tests used in the diagnosis of shoulder impingement: a Cochrane experience

Tags: Poster
Hanchard N, Handoll H

Background: Impingement is one of the most common causes of shoulder pain in adults, and results from the pinching of various soft-tissue structures adjacent to or within the shoulder joint on movement. The structures involved may include the rotator cuff (a musculo-tendinous complex surrounding the joint capsule), the lubricating sac (bursa) overlying it, or the rim of fibrocartilage (labrum) which deepens the shoulder jointÂ’s socket. When a person presents with shoulder pain, the clinician initially performs a series of physical tests in order to establish the diagnosis and inform treatment and prognosis. Subsequently, other diagnostic methods including ultrasound and arthroscopy are often used in cases of unresolved pain.

Objectives: To identify and review studies of diagnostic accuracy of physical tests of shoulder impingement. To help pilot Cochrane diagnostic review methods.

Methods: If possible we hope to apply, as well as to pilot, the methods developed by the Cochrane Diagnostic Methods Group. Currently, we have set up a protocol establishing the scope of the review, study inclusion criteria, search strategy and methods. We include studies testing the diagnostic accuracy of physical tests for shoulder impingements and/or rotator cuff tears in patients of any age presenting with symptoms indicative of underlying impingement. Though the reference standards are arthroscopy and open surgery, we will accept other reference tests such as ultrasound examination and local anaesthesia injections when used in primary care settings. We will search MEDLINE and reference lists of relevant articles. We will perform independent study selection, quality assessment and data extraction. Where possible and appropriate, quantitative analysis will be done.

Results: The full results will be available at the time of the Colloquium. In addition we plan to give some insights of our Cochrane experience.

Conclusions: We will draw some tentative, pre-peer review, conclusions on the value of physical examination and different physical tests in diagnosing the various types of shoulder impingement. We also anticipate being able to provide valuable insights on the Cochrane process.