Mohtadi 2004.

Clinical features and settings	Inclusion criteria: Patients with shoulder pain at night or with overhead activity greater than 3 months duration or both A minimum of 3 of the following 6 clinical findings: a painful arc of motion in the scapular plane (60° to 120°) of elevation; pain‐related weakness on resisted elevation in the scapular plane; Neer’s impingement sign; Hawkin’s impingement sign; point of maximal tenderness over the supraspinatus tendon; and positive impingement xylocaine test Failure of conservative management The patients consented to undergo shoulder arthroscopy and subacromial decompression Exclusion criteria: Patients with symptoms of instability Signs of instability Point of maximum tenderness over the acromioclavicular joint Any signs or symptoms consistent with associated cervical spine pathology Previous surgery, arthrography, ultrasound, or MRI Duration of symptoms: More than 3 months of symptoms Previous treatments: Conservative management (nonsteroidal anti‐inflammatory drugs, physiotherapy, home‐based rehabilitation, cortisone injections, and modification of activity) Care setting: Tertiary or secondary
Participants	Place of study: Calgary, Alberta, Canada Period of study: 1998 to 2000 Number of participants eligible: 73 participants Number of participants enrolled IT and RS: ‐ Indirect MRA and arthroscopy: 58 participants Data available for analyses: ‐ Indirect MRA and arthroscopy: 58 participants Age: mean 46.2 years (range 21 to 73 years) Male/Female: 43/15 Dominant arm: Not reported Nature of onset: Of these 58 patients, 91.4% reported pain at night and 96.6% reported pain with activity above shoulder level
Study design	Primary objective: To determine the diagnostic ability of MRI compared with a reference standard, arthroscopy, in patients presenting with shoulder pain consistent with the signs and symptoms of shoulder impingement Study design: Prospective, consecutive accuracy cohort study Language: English
Target condition and reference standard(s)	Target conditions: Presence full thickness tears and partial thickness supraspinatus tendon tears Presence of any infraspinatus tendon tears Presence of any subscapularis tendon tears Reference standard(s): Shoulder arthroscopy ‐ Description of technique: In accordance with the standardised 15‐point protocol of Snyder classification This included standard posterior and anterior portal examination with subsequent visualisation in the subacromial bursa The subacromial (bursal) examination was not performed All surgeries were videotaped ‐ Criteria for a positive result: Not reported
Index and comparator tests	Index test(s): Indirect MRA ‐ Description of technique: MRI unit: 1.5 T with conventional shoulder coil Sequences and Planes: Axial water density (TR/TR 1000/20) and multi‐planar gradient recalled (TR/TE 400/20, flip angle20o) Oblique coronal fast multi‐planar inversion recovery (TR/TE 4600/28, inversion time 150) Oblique coronal post‐gadolinium fat‐saturated T1‐weighted (TR/TE 400/8) and sagittal T1‐weighted (TR/TE 400/8) Contrast and procedure: Intravenous gadolinium administration Patient position: Supine with the arm in a neutral position ‐ Criteria for a positive result: Not reported ‐ Time from symptoms to index test: More than 3 months of symptoms ‐ Time from index test to reference standard: Upon entry into the study patients were scheduled to undergo MRI within 1 week before arthroscopy
Follow‐up	Adverse events due to index test(s): Not reported Adverse events due to reference standard test(s): Not reported
Notes	The analyses of rotator cuff tears were focused on only supraspinatus and subscapularis tendons tears No two‐by‐two table of the ITs and RS was given, but it was possible to back‐calculate this from the reported summary data
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Yes	Tertiary or secondary care, participants with suspected of having any rotator cuff tears The study was prospective and recruitment was consecutive
Acceptable reference standard? All tests	Yes	The reference standard was arthroscopy and the target conditions were presence full thickness tears and partial thickness supraspinatus tendon tears; presence of any infraspinatus tendon tears; presence of any subscapularis tendon tears
Acceptable delay between tests? All tests	Yes	Patients were scheduled to undergo MRI within 1 week before arthroscopy
Partial verification avoided? All tests	No	Not all the patients who received the index test underwent a reference standard to verify their true disease status Of the 73 eligible participants, eight cancelled the surgery and seven did not undergo MRI within a week and were excluded but their results were not reported
Differential verification avoided? All tests	Yes	All patients received the same reference standard regardless of the result of their index test
Incorporation avoided? All tests	Yes	The index test did not form part of the reference standard
Index test results blinded? All tests	Yes	The index tests were interpreted before and without knowledge of the reference standard results
Reference standard results blinded? All tests	Yes	Before and during diagnostic arthroscopy, the surgeon was blinded to the MRI results
Relevant clinical information? All tests	Unclear	Not reported
Uninterpretable results reported? All tests	Yes	The study was prospective recruitment was consecutive and results were reported for all initially included participants
Withdrawals explained? All tests	Yes	The number and reasons of all withdrawals from the study were explained
Learning curve / training reported of index test? All tests	Unclear	The interpreter of index tests was a musculoskeletal radiologist Training and expertise were not described
Learning curve / training reported of reference standard? All tests	Unclear	The reference standards were performed by two experienced orthopaedic surgeons Training and expertise were not described
Index test criteria for a positive test result reported? All tests	No	Not reported