Which test for rotator cuff tear following shoulder dislocation?

There are of course a number of papers looking at the same thing but I saw this one recently.

Yuen, Chi Kit, Ka Leung Mok, and Pui Gay Kan. “The Validity of 9 Physical Tests for Full-Thickness Rotator Cuff Tears After Primary Anterior Shoulder Dislocation in ED Patients..” The American Journal of Emergency Medicine 30, no. 8: 1522–1529. doi:10.1016/j.ajem.2011.12.022. PMID 22386341

Great study question  – in shoulder dislocation can we pick up full thickness tears at 10 day follow up using clinical exam?

METHODS

  • ultrasound by the trained EPs as gold standard – this could easily be questioned both in terms of training and in terms of modality – is MRI better?
  • the big problem was the EPs doing the ultrasound were the same guys who did the exam – there was no blinding here so you can effectively find what you want to.

RESULTS

  • 50 pts over 4 years (another problem…)
  • 40% had a tear
  • they conclude that the empty can test was the best – which is nice because that’s what I’ve been doing.
  • even at that sens was 90% and spec 55% for the empty can.

 

Desptite the obvious weaknesses of the paper tears are common and contribute to morbidity so they’re worth looking for

Here’s a video of the empty can test just as a refresher