Diagnostic accuracy of scapular physical examination tests for shoulder disorders: a systematic review Alexis A Wright, 1 Craig A Wassinger, 2 Mason Frank, 3 Lori A Michener, 4 Eric J Hegedus 1 ▸ Additional appendices are published online only. To view these files please visit the journal online (http://dx.doi.org/ 10.1136/bjsports-2012- 091573). 1 Department of Physical Therapy, High Point University, School of Health Sciences, High Point, North Carolina, USA 2 Department of Physical Therapy, East Tennessee State University, College of Clinical and Rehabilitative Health Sciences, Johnson City, Tennessee, USA 3 Department of Athletic Training, High Point University, School of Health Sciences, High Point, North Carolina, USA 4 Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia, USA Correspondence to Dr Alexis A Wright, Department of Physical Therapy, High Point University, School of Health Sciences, 833 Montlieu Ave., High Point, NC 27262, USA; awright@highpoint.edu ABSTRACT Objective To systematically review and critique the evidence regarding the diagnostic accuracy of physical examination tests for the scapula in patients with shoulder disorders. Methods A systematic, computerised literature search of PubMED, EMBASE, CINAHL and the Cochrane Library databases (from database inception through January 2012) using keywords related to diagnostic accuracy of physical examination tests of the scapula. The Quality Assessment of Diagnostic Accuracy Studies tool was used to critique the quality of each paper. Results Eight articles met the inclusion criteria; three were considered to be of high quality. Of the three high- quality studies, two were in reference to a ‘ diagnosis’ of shoulder pain. Only one high-quality article referenced specific shoulder pathology of acromioclavicular dislocation with reported sensitivity of 71% and 41% for the scapular dyskinesis and SICK scapula test, respectively. Conclusions Overall, no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder. INTRODUCTION Orthopedic physical examination tests have become standard practice when evaluating patients with shoulder pain in an effort to confirm or reject suspected diagnoses. Typically, assessment of the patient includes history, systems review, range of motion, accessory motions, strength testing and special tests for assessing the stability and integrity of the rotator cuff, labrum, and other periarticular structures. 12 Previous authors have reported on the diagnostic accuracy of a number of individual gle- nohumeral joint physical examination tests and their association with a wide variety of shoulder pathologies. 3 Testingat the glenohumeral joint only encompasses one of several joints comprising the shoulder joint complex. In prior studies, investiga- tors and clinicians, in an attempt to capture more comprehensively all of the joints of the shoulder complex, have focused on scapulohumeral move- ment and scapular position and movement tests to assist in the diagnostic process in patients with shoulder pathologies. 4–8 Given the contribution of the scapula to the normal movement pattern and stability of the shoulder, assessing scapular movement and position is considered an important part of the clinical examination. 9 10 The scapula acts as an area of force transfer and shoulder stability and is a critical component facilitating normal shoulder functional movements. 10–12 Typically, the goal of examination of the scapula is to identify the presence or absence of optimal scapular motion and position in the symptomatic patient, which, in turn, helps to guide specific treatment options. 10 What is lacking, is the ability to identify whether these altered posi- tions or motions are specific to those with shoulder pathology or if these alterations are part of a normal variation. When evaluating the scapula, the examiner typically observes both the resting and dynamic positioning and motion patterns of the scapula to determine if aberrant position or motion is present. 2 9 10 13 This may consist of abnormalities in the form of premature, excessive, or dysrhythmic motions during active elevation and/or lowering of the shoulder relative to the expected motions or upon bilateral comparison. 9 10 Other described tests use the manual positioning of the scapula to assess for symptom alteration during static 14 15 and dynamic conditions. 16 Prior studies described tests which relay the use- fulness of scapular examination for varied shoulder disorders. 15 17–19 The clinical utility of previously reported scapular examination tests to rule in or rule out shoulder pathology remains unclear and to this date, there has been no systematic review of the body of literature pertaining to the use of scapular tests in diagnosis. Therefore, the purpose of this study was to systematically review the evi- dence regarding scapular physical examination tests for specific shoulder pathology and provide clinicians with information to determine whether these tests are useful in clinical practice. METHODS This systematic review was conducted and reported according to the protocol outlined by PRISMA 20 using a research question framed by PICOS meth- odology. PICOS is a pneumonic representing popu- lation (eg, adults), intervention (eg, scapular physical examination tests used to diagnose shoul- der disorders), comparison (eg, control group), outcome (eg, diagnostic accuracy) and study design (eg, cohort). Identification and selection of the literature In order to make the search of articles on diagnos- tic accuracy as comprehensive as possible, we con- ducted a systematic, computerised search of the literature based on the combined recommendations of previous authors 21–24 in PUBMED, EMBASE, CINAHL and Cochrane Library databases (from Br J Sports Med 2012;0:1–8. doi:10.1136/bjsports-2012-091573 1 Review BJSM Online First, published on October 18, 2012 as 10.1136/bjsports-2012-091573 Copyright Article author (or their employer) 2012. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on October 19, 2012 - Published by bjsm.bmj.com Downloaded from