Swen 1998.

Clinical features and settings	Inclusion criteria: Patients awaiting surgery because of clinically suspected of rotator cuff tears The clinical diagnosis of rotator cuff tears was based on marked difficulty in initiating abduction of the arm with weakness and limitation of movement Lidocaine was injected below the acromion, if after the injection the strength of the rotator cuff was still decreased; this was considered to indicate rotator cuff tears Exclusion criteria: Patients with neurologic origins of the weakness Duration of symptoms: mean 2.3 years (range 0.3 to 10 years) Previous treatments: Not reported Care setting: Not reported, probably tertiary or secondary
Participants	Place of study: The Netherlands Period of study: January 1993 to December 1995 Number of participants eligible: 48 participants Number of participants enrolled IT and RS: ‐ US and arthroscopy or open surgery: 48 participants Data available for analyses: ‐ US and arthroscopy or open surgery: 48 participants Age: mean 55 years (range 30 to 76 years) Male/Female: 28/20 Dominant arm: Not reported Nature of onset: Not reported
Study design	Primary objective: To compare the diagnostic value of US performed by the rheumatologist with that of arthrography by a radiologist for otherwise healthy patients with suspected rotator cuff tears Study design: Prospective consecutive accuracy cohort study Language: English
Target condition and reference standard(s)	Target conditions: Presence full thickness tears Reference standard(s): Shoulder arthroscopy and open surgery ‐ Description of technique: Not reported ‐ Criteria for a positive result: A full‐thickness was diagnosed if free communication was found between the bursal and humeral sides of the cuff
Index and comparator tests	Index test(s): US ‐ Description of technique: Scanner: 7.5 MHz linear array and the 5.0 MHz curved array transducers Technique: The shoulder was examined in the anterior, lateral, and posterior directions, in both the transverse and the longitudinal planes as described by Van Holsbeeck 1991 Patient position: The patients were seated For the anterior approach, the patient’s upper arm was visualised in internal rotation, which was achieved by placing the patient’s hand behind the back ‐ Criteria for a positive result: Full thickness tears: a discontinuity in the rotator cuff extending from the bursal to the humeral side of the rotator cuff ‐ Time from symptoms to index test: Not reported ‐ Time from index test to reference standard: Not reported
Follow‐up	Adverse events due to index test(s): Not reported Adverse events due to reference standard test(s): Not reported
Notes	A two‐by‐two table of the ITs and RS was given which tallied with 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 or open surgery and the target conditions were presence of full thickness tears
Acceptable delay between tests? All tests	Unclear	The study did not report the time elapsed between the index tests and reference standard
Partial verification avoided? All tests	Yes	All patients who received the index test went on to receive verification of their disease status using a reference standard
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 study was prospective and the results of the index tests were interpreted before the reference standard
Reference standard results blinded? All tests	Unclear	Insufficient information was given to permit judgement
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	No participants were excluded from the analysis
Learning curve / training reported of index test? All tests	Yes	The interpreter of index tests was a rheumatologist with experience in this technique
Learning curve / training reported of reference standard? All tests	Unclear	Insufficient information was given to permit judgement
Index test criteria for a positive test result reported? All tests	Yes	The study reported the definition of a positive index test result