The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears

Autor: Paul F Abraham, Stephen M. Gillinov, Mark R. Nazal, Nathan H. Varady, Noah J. Quinlan, Kyle Alpaugh, Scot T. Martin
Rok vydání: 2020
Předmět:
Zdroj: Journal of Shoulder and Elbow Surgery. 29:2213-2220
ISSN: 1058-2746
DOI: 10.1016/j.jse.2020.06.029
Popis: Background Traditional shoulder physical examination (PE) tests have suboptimal sensitivity for detection of supraspinatus full-thickness tears (FTTs). Therefore, clinicians may continue to suspect FTTs in some patients with negative rotator cuff PE tests and turn to magnetic resonance imaging (MRI) for definitive diagnosis. Consequently, there is a need for a secondary screening test that can accurately rule out FTTs in these patients to better inform clinicians which patients should undergo MRI. The purpose of this study was to assess the ability of two new dynamic PE tests to detect supraspinatus pathology in patients for whom traditional static PE tests failed to detect pathology. Methods We prospectively enrolled 171 patients with suspected rotator cuff pathology with negative findings on traditional rotator cuff PE, who underwent two new dynamic PE tests: first, measurement of angle at which the patient first reports pain on unopposed active abduction and, second, the dynamic isotonic manipulation examination (DIME). Patients then underwent shoulder magnetic resonance arthrogram (MRA). Data from the new PE maneuvers were compared to outcomes collected from MRA reports. Results Pain during DIME testing had a sensitivity of 96.3% and 92.6% and negative predictive value (NPV) of 96.2% and 94.9% in the coronal and scapular planes, respectively. DIME strength ≤86.0 N had a sensitivity of 100% and 96.3% and NPV of 100% and 95.7% in the coronal and scapular planes, respectively. Pain at ≤90° on unopposed active abduction in the coronal plane had a specificity of 100% and positive predictive value of 100% for supraspinatus pathology of any kind (i.e. tendinopathy, “fraying”, or tearing). Conclusion DIME is highly sensitive for supraspinatus FTTs in patients with negative traditional rotator cuff PE tests for whom there is still high clinical suspicion of FTTs. Thus, this test is an excellent secondary screening tool for supraspinatus FTTs in patients for whom clinicians suspect rotator cuff pathology despite negative traditional static PE tests. Given its high sensitivity, a negative DIME test rules out supraspinatus FTT well in these patients, and can therefore better inform clinicians which patients should undergo MRI. In addition, the angle at which patients first report pain on unopposed active shoulder abduction is highly specific for supraspinatus pathology. Study Design Level II; Diagnosis Study
Databáze: OpenAIRE
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