Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears: a prospective study
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Early diagnosis of traumatic acute full-thickness rotator cuff tears (FTRCT) is important to offer early surgical repair. Late repairs following fatty infiltration of the rotator cuff muscles have less favorable results. We think that physical therapists are valuable diagnosticians in a screening process. The objective of this study was to evaluate the usefulness of physical therapists as first-line diagnosticians in detecting acute traumatic FTRCT.
Between November 2010 and January 2014, 394 consecutive patients having an age between 18 and 75 years who sought medical care because of acute shoulder trauma with acute onset of pain, limited abduction and negative plain radiographs were included in the study. A clinical assessment was conducted by a physical therapist 1 week after the trauma. The patients were divided into three groups by the physical therapist according to the findings: FTRCT (Group I, n = 122); sprain (Group II, n = 62); or other specific diagnoses (Group III, n = 210). Group III patients were discharged and excluded from the study. Magnetic Resonance Imaging shoulder was performed for all Group I patients and for all patients with persistent symptoms in Group II.
79/184 patients had FTRCTs documented by MRI in groups I and II. The clinical assessment of the physical therapist had a sensitivity of 85%, specificity of 68%, and usefulness index of 0.45 (> 0.35 considered useful) for diagnosing FTRCT.
Physical therapists can be useful as first-line diagnosticians in detecting traumatic FTRCT.
KeywordsRotator cuff tear Physical therapist Usefulness index Shoulder injury Physical examination
Acute Shoulder Assessment Project
Full-thickness rotator cuff tears
Magnetic resonance imaging
Number of excitations
The Swedish National Musculoskeletal Competence Center
Field of view
Turbo spin echo
Short tau inversion recovery
The authors thank the physical therapists Anna Lönnberg and Madelaine Andersson for their clinical examination and monitoring the study and Dr. Torsten Boegård for MRI reviews and radiological advice.
Compliance with ethical standards
Conflict of interest
Knut E Aagaard, Jonas Hänninen, Fikri Abu-Zidan, and Karl Lunsjo declare that they have no conflict of interest.
Research involving human participant
The study was approved by the regional Ethical review Board in Lund, Sweden, 2011 (Registration Number 2011/119) and met the standards outlined in the Declaration of Helsinki.
An informed consent was taken from all patients who have participated in this study.
This study was supported by grants from the Stig och Ragna Gorthon Foundation, Helsingborg, Sweden.
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