Shoulder
External rotation lag sign revisited: Accuracy for diagnosis of full thickness supraspinatus tear

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Hypothesis

This study reassessed the sensitivity and the specificity of the external rotator lag sign (ERLS) for diagnosis of supraspinatus tears in a large cohort of patients.

Materials and methods

The ERLS was used to assess 401 consecutive patients with 406 painful shoulder conditions. The clinical diagnosis was controlled either arthroscopically or by open surgery.

Results

For isolated full-thickness supraspinatus tears, the ERLS had a sensitivity of 56% and a specificity of 98%. When the lesion involved the infraspinatus and the teres minor the sensitivity improved substantially. There was a strong correlation between the extension of the tear and the amount of the lag. The lag increased from 7° for an isolated rupture of the supraspinatus tendon to 26° in case of extension to the teres minor.

Conclusion

The ERLS is highly specific and acceptably sensitive for diagnosis of full-thickness tears, even in case of an isolated lesion of the supraspinatus tendon.

Level of evidence

Level 2; Prospective cohort treatment study.

Section snippets

Materials and methods

Between January 2004 and June 2006, we collected data on signs and symptoms of patients affected by shoulder diseases. The data of 401 consecutive patients (406 shoulders) with painful shoulders conditions examined by the same surgeon were retrospectively analyzed for this study. We excluded 11 patients because the electronic files were lost. Data from 390 patients and 395 shoulders (226 men, 169 women) were available for analysis. Patients were a mean age of 50 ± 16 years (range, 16-89 years).

PTT of the supraspinatus

As expected, the ERLS was not able to identify PTT of the supraspinatus. The very low number of true-positive results determined a sensitivity of only 12%; however, the specificity was nearly 100% owing to a high percentage of true-negative results (Table II). The presence of a subscapularis tear slightly increased the sensitivity of the test, but this determined a similar increase in false-positive results and therefore a loss in accuracy.

Isolated supraspinatus full-thickness tear

An isolated lesion of the anterior half of the

Discussion

A physical examination of rotator cuff disease is essential for cost-efficient planning of eventual imaging studies. Because the most frequent tear occurs in the supraspinatus tendon, it is important to use signs that specifically detect this tear. Supraspinatus tears occur in different patterns: partial-thickness tears (joint side, bursal side, intratendinous tears), full-thickness tears involving the anterior or the posterior part of the tendon, or both, and cleavage or delamination

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