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. 1999 May;58(5):272–277. doi: 10.1136/ard.58.5.272

Diagnostic classification of shoulder disorders: interobserver agreement and determinants of disagreement

A F de Winter 1, M Jans 1, R Scholten 1, W Deville 1, D van Schaardenburg 1, L Bouter 1
PMCID: PMC1752887  PMID: 10225810

Abstract

OBJECTIVES—To assess the interobserver agreement on the diagnostic classification of shoulder disorders, based on history taking and physical examination, and to identify the determinants of diagnostic disagreement.
METHODS—Consecutive eligible patients with shoulder pain were recruited in various health care settings in the Netherlands. After history taking, two physiotherapists independently performed a physical examination and subsequently the shoulder complaints were classified into one of six diagnostic categories: capsular syndrome (for example, capsulitis, arthritis), acute bursitis, acromioclavicular syndrome, subacromial syndrome (for example, tendinitis, chronic bursitis), rest group (for example, unclear clinical picture, extrinsic causes) and mixed clinical picture. To quantify the interobserver agreement Cohen's κ was calculated. Multivariate logistic regression analysis was applied to determine which clinical characteristics were determinants of diagnostic disagreement.
RESULTS—The study population consisted of 201 patients with varying severity and duration of complaints. The κ for the classification of shoulder disorders was 0.45 (95% confidence intervals (CI) 0.37, 0.54). Diagnostic disagreement was associated with bilateral involvement (odds ratio (OR) 1.9; 95% CI 1.0, 3.7), chronic complaints (OR 2.0; 95% CI 1.1, 3.7), and severe pain (OR 2.7; 95% CI 1.3, 5.3).
CONCLUSIONS—Only moderate agreement was found on the classification of shoulder disorders, which implies that differentiation between the various categories of shoulder disorders is complicated. Especially patients with high pain severity, chronic complaints and bilateral involvement represent a diagnostic challenge for clinicians. As diagnostic classification is a guide for treatment decisions, unsatisfactory reproducibility might affect treatment outcome. To improve the reproducibility, more insight into the reproducibility of clinical findings and the value of additional diagnostic procedures is needed.



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Selected References

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  1. Balich S. M., Sheley R. C., Brown T. R., Sauser D. D., Quinn S. F. MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. Radiology. 1997 Jul;204(1):191–194. doi: 10.1148/radiology.204.1.9205245. [DOI] [PubMed] [Google Scholar]
  2. Bamji A. N., Erhardt C. C., Price T. R., Williams P. L. The painful shoulder: can consultants agree? Br J Rheumatol. 1996 Nov;35(11):1172–1174. doi: 10.1093/rheumatology/35.11.1172. [DOI] [PubMed] [Google Scholar]
  3. Brennan P., Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992 Jun 6;304(6840):1491–1494. doi: 10.1136/bmj.304.6840.1491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chard M. D., Sattelle L. M., Hazleman B. L. The long-term outcome of rotator cuff tendinitis--a review study. Br J Rheumatol. 1988 Oct;27(5):385–389. doi: 10.1093/rheumatology/27.5.385. [DOI] [PubMed] [Google Scholar]
  5. Croft P., Pope D., Silman A. The clinical course of shoulder pain: prospective cohort study in primary care. Primary Care Rheumatology Society Shoulder Study Group. BMJ. 1996 Sep 7;313(7057):601–602. doi: 10.1136/bmj.313.7057.601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Croft P. The epidemiology of pain: the more you have, the more you get. Ann Rheum Dis. 1996 Dec;55(12):859–860. doi: 10.1136/ard.55.12.859. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Deutsch A. L., Klein M. A., Mink J. H., Mandelbaum B. R. MR imaging of miscellaneous disorders of the shoulder. Magn Reson Imaging Clin N Am. 1997 Nov;5(4):881–895. [PubMed] [Google Scholar]
  8. Fritz R. C., Stoller D. W. MR imaging of the rotator cuff. Magn Reson Imaging Clin N Am. 1997 Nov;5(4):735–754. [PubMed] [Google Scholar]
  9. Grechenig W., Clement H. G., Schatz B., Grechenig M. Stellenwert der Sonographie am Stütz- und Bewegungsapparat--unter besonderer Berücksichtigung von Strahlenbelastung und Kostenreduktion. Biomed Tech (Berl) 1997 May;42(5):132–137. doi: 10.1515/bmte.1997.42.5.132. [DOI] [PubMed] [Google Scholar]
  10. Green S., Buchbinder R., Glazier R., Forbes A. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ. 1998 Jan 31;316(7128):354–360. doi: 10.1136/bmj.316.7128.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hedtmann A., Fett H. Die sogenannte Periarthropathia humeroscapularis--Klassifizierung und Analyse anhand von 1266 Fällen. Z Orthop Ihre Grenzgeb. 1989 Nov-Dec;127(6):643–649. doi: 10.1055/s-2008-1040306. [DOI] [PubMed] [Google Scholar]
  12. Larson H. M., O'Connor F. G., Nirschl R. P. Shoulder pain: the role of diagnostic injections. Am Fam Physician. 1996 Apr;53(5):1637–1647. [PubMed] [Google Scholar]
  13. Miller M. E., Hui S. L., Tierney W. M. Validation techniques for logistic regression models. Stat Med. 1991 Aug;10(8):1213–1226. doi: 10.1002/sim.4780100805. [DOI] [PubMed] [Google Scholar]
  14. Neer C. S., 2nd Impingement lesions. Clin Orthop Relat Res. 1983 Mar;(173):70–77. [PubMed] [Google Scholar]
  15. Neviaser R. J. Painful conditions affecting the shoulder. Clin Orthop Relat Res. 1983 Mar;(173):63–69. [PubMed] [Google Scholar]
  16. Pellecchia G. L., Paolino J., Connell J. Intertester reliability of the cyriax evaluation in assessing patients with shoulder pain. J Orthop Sports Phys Ther. 1996 Jan;23(1):34–38. doi: 10.2519/jospt.1996.23.1.34. [DOI] [PubMed] [Google Scholar]
  17. Scheier M. F., Carver C. S. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 1985;4(3):219–247. doi: 10.1037//0278-6133.4.3.219. [DOI] [PubMed] [Google Scholar]
  18. Tsao L. Y., Mirowitz S. A. MR imaging of the shoulder. Imaging techniques, diagnostic pitfalls, and normal variants. Magn Reson Imaging Clin N Am. 1997 Nov;5(4):683–704. [PubMed] [Google Scholar]
  19. Uhthoff H. K., Sarkar K. An algorithm for shoulder pain caused by soft-tissue disorders. Clin Orthop Relat Res. 1990 May;(254):121–127. [PubMed] [Google Scholar]
  20. Uhthoff H. K., Sarkar K. Classification and definition of tendinopathies. Clin Sports Med. 1991 Oct;10(4):707–720. [PubMed] [Google Scholar]
  21. Vecchio P. C., Kavanagh R. T., Hazleman B. L., King R. H. Community survey of shoulder disorders in the elderly to assess the natural history and effects of treatment. Ann Rheum Dis. 1995 Feb;54(2):152–154. doi: 10.1136/ard.54.2.152. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Winters J. C., Groenier K. H., Sobel J. S., Arendzen H. H., Meyboom-de Jongh B. Classification of shoulder complaints in general practice by means of cluster analysis. Arch Phys Med Rehabil. 1997 Dec;78(12):1369–1374. doi: 10.1016/s0003-9993(97)90312-9. [DOI] [PubMed] [Google Scholar]
  23. ZUNG W. W. A SELF-RATING DEPRESSION SCALE. Arch Gen Psychiatry. 1965 Jan;12:63–70. doi: 10.1001/archpsyc.1965.01720310065008. [DOI] [PubMed] [Google Scholar]
  24. van der Windt D. A., Koes B. W., Boeke A. J., Devillé W., De Jong B. A., Bouter L. M. Shoulder disorders in general practice: prognostic indicators of outcome. Br J Gen Pract. 1996 Sep;46(410):519–523. [PMC free article] [PubMed] [Google Scholar]

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