shoulders are magic

Balls, Sockets, SLAPs, and Taps – reliable, evidence-based exam maneuvers to illuminate the Glenoid Cavity

Big shout-out to G.G. this week who SLAPped together a last-minute Teaching Tuesday session on the shoulder AND tricked had Sports Medicine Specialist Dr. John Touhy join in!

The first Clinical Pearl – check your eponyms at the door. That’s right. It turns out that the mile-long list of eponymous PEX maneuvers you memorized during Medical School does very little to bolster your diagnostic acumen when you see that next Weekend Warrior.

look familiar? don’t worry b/c it turns out that performing these maneuvers with a patient is little more than intellectual navel gazing

Enter JAMA’s Rational Clinical Exam series and its Meta-Analysis identifying the PEX maneuvers that YOU can actually use in REAL LIFE toaccurately diagnose the MOST COMMON CAUSE OF shoulder pain – Rotator Cuff Disease (RCD). Shoulder Pain and Rotator Cuff Disease

The Bottom Line – Only TWO PEX findings reliably identify RCD … and neither Neers nor Hawkins make the cut.
  1. A positive painful arc test result was the only finding with a positive LR greater than 2.0 for RCD (3.7 [95% CI, 1.9-7.0]), and a normal painful arc test result had the lowest negative LR (0.36 [95% CI, 0.23-0.54a positive external rotation lag test (LR, 7.2 [95% CI, 1.7-31]) and internal rotation lag test (LR, 5.6 [95% CI, 2.6-12]) were the most accurate findings for full-thickness tears]) – among pain provocation tests
  2. A positive external rotation lag test (LR, 7.2 [95% CI, 1.7-31]) and internal rotation lag test (LR, 5.6 [95% CI, 2.6-12]) were the most accurate findings for full-thickness tears – among strength tests.

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