Original articleThe Validity of the Lag Signs in Diagnosing Full-Thickness Tears of the Rotator Cuff: A Preliminary Investigation
Section snippets
Study Design
A same-subject, correlational, double-blinded design was used in this study. Ethics approval was obtained from Coventry University and South Birmingham Ethics Committee before commencing the study. Subjects were informed of their rights, including the right to withdraw from the investigation at any stage without providing an explanation.
Study Sample
Thirty-seven subjects with shoulder pain referred to a consultant orthopedic surgeon specializing in shoulder conditions were recruited for this investigation.
Results
The final patient group recruited for the study was composed of 37 patients, 16 men and 21 women. The average patient age was 55.5 years (range, 20–86y), and the average length of time since onset of shoulder pain was 37.5 months (range, 4–120mo). Nine subjects presented with bilateral shoulder pain. Therefore, results from 46 symptomatic shoulders were analyzed. Fifteen of 46 of the shoulders assessed had a full-thickness tear on ultrasound, giving a symptomatic prevalence rate of 33%. Only 6%
Discussion
With the specificity of 94% for the external rotation lag sign, clinicians should have some confidence in interpreting a positive result as indicating the presence of full-thickness tears of both the supraspinatus and infraspinatus. This finding is supported by the positive likelihood ratio of 7.2 (95% CI, 1.7–31.0), which suggests a moderate increase in the likely presence of full-thickness tears.25 However, the poor lower end of the 95% CI together with the width of the CI strongly suggests
Conclusions
Diagnostic ultrasound has been shown to have a detection rate of full-thickness tears of the rotator cuff comparable to that of arthroscopy, which is considered to be the criterion standard reference test. In addition, ultrasound has the advantage of allowing a comparison of the clinical findings in a blinded manner, which for ethical and pragmatic reasons is not possible when clinical findings are compared with arthroscopy. Another benefit of ultrasound is that is allows a bilateral
Acknowledgments
We thank Marcus Green, MD, and Gina Allen, MD, for their assistance with this research. Thanks also to Catherine Elliott, MSc, MCSP, for her support.
References (41)
- et al.
Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation
Man Ther
(2006) - et al.
Is supraspinatus pathology as defined by magnetic resonance imaging associated with clinical sign of shoulder impingement?
J Shoulder Elbow Surg
(1999) - et al.
Transdeltoid palpation (the rent test) in the diagnosis of rotator cuff tears
J Shoulder Elbow Surg
(2001) - et al.
Lag signs in the diagnosis of rotator cuff rupture
J Shoulder Elbow Surg
(1996) - et al.
The reliability between surgeons comparing arthroscopic and video evaluation of patients with shoulder impingement syndrome
Arthroscopy
(2004) - et al.
Isometric abduction muscle activation in patients with rotator tendinosis of the shoulder
Arch Phys Med Rehabil
(1997) - et al.
A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears
J Shoulder Elbow Surg
(2002) - et al.
Vascular endothelial growth factor (VEGF) expression in the subacromial bursa is increased in patients with impingement syndrome
J Orthop Res
(2001) - et al.
Sensory nerve supply in the human subacromial bursa
J Shoulder Elbow Surg
(1996) - et al.
Interleukin-1-induced glenohumeral synovitis and shoulder pain in rotator cuff diseases
J Orthop Res
(2002)
Internal rotation resistance strength test: a new diagnostic test to differentiate intra-articular pathology from outlet (Neer) impingement syndrome in the shoulder
J Shoulder Elbow Surg
Normal and abnormal motion of the shoulder
J Bone Joint Surg Am
Forces at the glenohumeral joint in abduction
Clin Orthop Relat Res
The relative strengths of the rotator cuff muscles: a cadaver study
J Bone Joint Surg Br
An algorithm for shoulder pain caused by soft-tissue disorders
Clin Orthop Relat Res
Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review
Br J Sports Med
Abnormal findings on magnetic resonance images of asymptomatic shoulders
J Bone Joint Surg Am
Rotator-cuff changes in asymptomatic adults: the effect of age, hand dominance and gender
J Bone Joint Surg Br
Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report
J Bone Joint Surg Am
Impingement lesions
Clin Orthop Relat Res
Cited by (44)
Management of irreparable subscapularis tears: Current concepts
2024, Journal of ISAKOSThe new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears
2020, Journal of Shoulder and Elbow SurgeryExternal rotator strength deficits in non-athletic people with rotator cuff related shoulder pain are not associated with pain intensity or disability levels
2020, Musculoskeletal Science and PracticeDiagnostic Value of Clinical Tests for Infraspinatus Tendon Tears
2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :In combination with the RERT, however, the Patte sign achieved a sufficient AUC and significant correlation with the intraoperative findings. There was no agreement among prior studies regarding the diagnostic quality of the ERLS.7,10 Miller et al.10 analyzed the ERLS in 37 patients and used ultrasound as a reference test.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.