# A comparative study of diagnostic performance in shoulder pain: clinical tests versus ultrasonography and magnetic resonance imaging

## TL;DR

This study compares the accuracy of clinical tests with imaging methods like ultrasound and MRI for diagnosing shoulder pain conditions.

## Contribution

The study provides a direct comparison of clinical tests' diagnostic performance against US and MRI for specific shoulder pathologies.

## Key findings

- Clinical tests showed higher sensitivity than US for subacromial impingement and biceps tendinitis.
- Clinical tests had higher specificity than MRI for acromioclavicular arthritis and rotator cuff rupture.
- MRI remains important for shoulder imaging despite the effectiveness of clinical tests.

## Abstract

Shoulder pain is common and often evaluated with physical examination tests, yet their diagnostic accuracy remains controversial. The aim of this cross-sectional study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) rates of clinical test results in patients with shoulder pain, based on ultrasonography (US) and magnetic resonance imaging (MRI) findings as reference diagnostic methods.

The study included 78 patients who had complaints of shoulder pain. All patients underwent physical examinations and specific clinical tests (such as Neer and Jobe tests) to reveal shoulder pathologies, and US and MRI evaluations were performed.

The sensitivity of clinical examination tests for subacromial impingement syndrome, biceps tendinitis and rupture, and infraspinatus tendinitis was higher than US. The specificity of tests for biceps rupture, rotator cuff rupture, infraspinatus and subscapularis tendinitis was higher compared with US. Subacromial impingement tests also showed higher sensitivity compared to MRI. The specificity of tests for acromioclavicular arthritis, biceps rupture, rotator cuff rupture, infraspinatus tendinitis was higher than MRI. Comparison of diagnostic performance with US was significant for subacromial impingement syndrome, acromioclavicular arthritis, biceps tendinitis and rupture, rotator cuff rupture and subscapularis tendinitis (p values; 0.003, 0.003, 0.000, 0.026, 0.000, 0.000, respectively). In contrast, comparison with MRI was significant only for subacromial impingement syndrome (p = 0.026).

Clinical tests have an important place in practice when examining shoulder lesions with their high specificity and sensitivity. Although US reveals many shoulder lesions that cannot be detected by clinical tests or support our examination, MRI maintains its importance in shoulder imaging.