Table 4.
Diagnostic Accuracy of Clinical Tests for Subscapularis Tears vs Reference Observations a
| Clinical Test | Sensitivity (95% CI) | Specificity (95% CI) | PPV (95% CI) | NPV (95% CI) | DOR (95% CI) |
|---|---|---|---|---|---|
| Bear-hug test | |||||
| Kappe (2018) 21 | 0.52 (—) | 0.85 (—) | 0.59 (—) | 0.81 (—) | 2.0 (1.2-3.2) |
| Takeda (2016) 37 | 0.74 (0.58-0.85) | 0.97 (0.91-0.99) | 0.93 (0.79-0.98) | 0.88 (0.80-0.93) | 105.0 (21.6-509.3) |
| Lin (2015) 25 | 0.70 (0.60-0.79) | 0.80 (0.73-0.86) | 0.67 (0.57-0.76) | 0.82 (0.75-0.88) | 9.4 (5.0-17.4) |
| Yoon (2013) 39 | 0.19 (0.12-0.30) | 0.99 (0.94-1.00) | 0.93 (0.69-0.99) | 0.64 (0.56-0.71) | 22.7 (2.9-178.2) |
| Barth (2006) 4 | 0.60 (0.39-0.78) | 0.92 (0.80-0.97) | 0.75 (0.51-0.90) | 0.85 (0.72-0.92) | 16.5 (4.2-64.2) |
| Belly-off sign | |||||
| Kappe (2018) 21 | 0.31 (—) | 0.97 (—) | 0.83 (—) | 0.77 (—) | 4.6 (1.3-16.5) |
| Bartsch (2010) 5 | 0.87 (0.62-0.96) | 0.91 (0.78-0.97) | 0.81 (0.57-0.93) | 0.94 (0.81-0.98) | 69.3 (10.4-464.4) |
| Belly-press test | |||||
| Kappe (2018) 21 | 0.34 (—) | 0.96 (—) | 0.79 (—) | 0.77 (—) | 3.7 (1.3-10.1) |
| Lin (2015) 25 | 0.64 (0.54-0.74) | 0.80 (0.73-0.85) | 0.65 (0.55-0.74) | 0.79 (0.72-0.85) | 7.1 (3.9-12.9) |
| Somerville (2014) 36 | 0.30 (0.15-0.52) | 0.97 (0.92-0.99) | 0.67 (0.35-0.88) | 0.88 (0.82-0.93) | 15.3 (3.4-68.1) |
| Yoon (2013) 39 | 0.28 (0.21-0.36) | 0.99 (0.97-1.00) | 0.97 (0.87-1.00) | 0.65 (0.59-0.70) | 68.6 (9.3-507.8) |
| Bartsch(2010) 5 | 0.88 (0.64-0.97) | 0.68 (0.51-0.81) | 0.56 (0.37-0.73) | 0.92 (0.75-0.98) | 14.6 (2.8-76.0) |
| Barth (2006) 4 | 0.40 (0.22-0.61) | 0.98 (0.88-1.00) | 0.89 (0.57-0.98) | 0.77 (0.64-0.87) | 27.3 (3.1-240.9) |
| Somerville (2014) 36,b | 0.50 (0.22-0.79) | 0.96 (0.91-0.98) | 0.44 (0.19-0.73) | 0.97 (0.92-0.99) | 23.4 (4.5-121.8) |
| Lasbleiz (2014) 23 ,b,c | 0.40 (0.05-0.85) | 0.74 (0.57-0.87) | 0.18 (0.02-0.52) | 0.89 (0.72-0.98) | — |
| Lasbleiz (2014) 23,b | 0.60 (0.15-0.95) | 1.00 (0.90-1.00) | 1.00 (0.29-0.71) | 0.94 (0.81-0.99) | — |
| IRLS | |||||
| Kappe (2018) 21 | 0.41 (—) | 0.91 (—) | 0.65 (—) | 0.78 (—) | 2.4 (1.3-4.4) |
| Lin (2015) 25 | 0.32 (0.22-0.43) | 0.92 (0.87-0.96) | 0.71 (0.55-0.84) | 0.69 (0.62-0.76) | 5.5 (2.5-12.1) |
| Somerville (2014) 36 | 0.05 (0.01-0.25) | 0.96 (0.91-0.99) | 0.20 (0.04-0.62) | 0.86 (0.79-0.91) | 2.0 (0.3-13.4) |
| Yoon (2013) 39 | 0.20 (0.14-0.28) | 0.97 (0.93-0.99) | 0.82 (0.66-0.91) | 0.62 (0.56-0.68) | 6.9 (2.8-16.8) |
| Bartsch (2010) 5 | 0.71 (0.45-0.88) | 0.60 (0.42-0.75) | 0.45 (0.27-0.65) | 0.82 (0.62-0.93) | 3.5 (0.9-12.9) |
| Somerville (2014) 36,b | 0.00 (0.00-0.37) | 0.96 (0.90-0.98) | 0.08 (0.00-0.48) | 0.93 (0.88-0.97) | 1.3 (0.1-25.1) |
| Miller (2008) 30,b | 1.00 (—) | 0.84 (—) | 0.28 (—) | 1.00 (—) | — |
| IRRT d | |||||
| Lin (2015) 25 | |||||
| 0° | 0.61 (0.51-0.71) | 0.76 (0.69-0.83) | 0.61 (0.50-0.70) | 0.77 (0.69-0.83) | 5.1 (2.9-9.1) |
| 90° | 0.77 (0.66-0.84) | 0.80 (0.73-0.86) | 0.69 (0.59-0.78) | 0.86 (0.79-0.91) | 13.4 (6.9-25.9) |
| Lift-off test | |||||
| Kappe (2018) 21 | 0.35 (—) | 0.98 (—) | 0.90 (—) | 0.76 (—) | 8.7 (1.3-56.7) |
| Takeda (2016) 37 | 0.65 (0.51-0.77) | 0.95 (0.87-0.98) | 0.87 (0.72-0.95) | 0.81 (0.72-0.88) | 28.5 (9.3-88.0) |
| Lin (2015) 25 | 0.60 (0.49-0.70) | 0.69 (0.60-0.76) | 0.55 (0.44-0.65) | 0.73 (0.65-0.80) | 3.3 (1.8-5.9) |
| Lasbleiz (2014) 23,e | 0.75 (0.19-0.99) | 0.91 (0.76-0.98) | 0.50 (0.12-0.88) | 0.97 (0.84-1.00) | — |
| Somerville (2014) 36 | 0.22 (0.10-0.44) | 0.96 (0.91-0.99) | 0.50 (0.23-0.77) | 0.87 (0.80-0.92) | 6.8 (1.7-27.9) |
| van Kampen (2014) 38 | 0.14 (0.06-0.28) | 1.00 (0.94-1.00) | 0.92 (0.52-0.99) | 0.65 (0.55-0.74) | 20.5 (1.1-382.5) |
| Yoon (2013) 39 | 0.12 (0.08-0.19) | 1.00 (0.98-1.00) | 0.97 (0.77-1.00) | 0.60 (0.55-0.66) | 50.4 (3.0-848.4) |
| Bartsch (2010) 5 | 0.41 (0.21-0.64) | 0.79 (0.62-0.90) | 0.50 (0.25-0.74) | 0.72 (0.55-0.84) | 2.5 (0.7-9.3) |
| Salaffi (2010) 34 | 0.35 (0.25-0.48) | 0.75 (0.67-0.82) | 0.85 (0.70-0.90) | 0.21 (0.16-0.20) | — |
| Kim (2007) 22,e | 0.06 (—) | 0.23 (—) | |||
| Barth (2006) 4 | 0.19 (0.07-0.42) | 1.00 (0.92-1.00) | 0.88 (0.40-0.99) | 0.77 (0.65-0.86) | 22.4 (1.1-460.6) |
| Itoi (2006) 19,c | 0.47 (0.30-0.64) | 0.69 (0.61-0.77) | 0.25 (0.15-0.38) | 0.86 (0.78-0.91) | 2.0 (0.9-4.5) |
| Itoi (2006) 19,f | 0.78 (0.60-0.90) | 0.59 (0.50-0.67) | 0.29 (0.20-0.40) | 0.93 (0.85-0.97) | 24.8 (1.2-531.8) |
| Itoi (2006) 19,g | 0.09 (0.02-0.23) | 1.00 (0.97-1.00) | 1.00 (0.34-1.00) | 0.83 (0.77-0.88) | 4.9 (1.9-12.6) |
| Lasbleiz (2014) 23,b | 0.50 (0.07-0.93) | 1.00 (0.90-1.00) | 1.00 (0.16-1.00) | 0.94 (0.81-0.99) | — |
| Somerville (2014) 36,b | 0.28 (0.09-0.59) | 0.95 (0.90-0.98) | 0.25 (0.07-0.59) | 0.95 (0.90-0.98) | 6.8 (1.3-35.6) |
| Napoleon test | |||||
| Takeda (2016) 37 | 0.63 (0.49-0.75) | 0.90 (0.81-0.95) | 0.80 (0.65-0.90) | 0.79 (0.69-0.86) | 14.7 (5.8-37.2) |
| Barth (2006) 4 | 0.25 (0.11-0.47) | 0.98 (0.89-1.00) | 0.83 (0.44-0.97) | 0.76 (0.64-0.85) | 15.7 (1.7-144.9) |
| Supine Napoleon test | |||||
| Takeda (2016) 37 | 0.84 (0.72-0.92) | 0.96 (0.89-0.99) | 0.94 (0.83-0.98) | 0.90 (0.82-0.95) | 134.4 (33.8-533.5) |
a Unless specified otherwise, all authors considered lack of strength/weakness a positive test result. Dashes indicate data not reported. DOR, diagnostic odds ratio; IRLS, internal rotation lag sign; IRRT, internal rotation resistance test; NPV, negative predictive value; PPV, positive predictive value.
b Full-thickness tears.
c Pain was used as a criterion for a positive test result.
d IRRT at 0° of abduction and 0° of external rotation is performed with the arm at the side and the elbow flexed to 90°. IRRT at maximal 90° of abduction and maximal external rotation is performed with the shoulder at maximal 90° of abduction and maximal external rotation and the elbow flexed to 90°.
e We followed the authors’ categorization as lift-off tests; however, passive lift-off tests correspond to IRLS.
f Authors graded manual muscle strength from normal amount of resistance to applied force (grade 5) to no muscle contraction (grade 0). This cohort had weakness grade <5.
g Authors graded manual muscle strength from normal amount of resistance to applied force (grade 5) to no muscle contraction (grade 0). This cohort had weakness grade <2.