SAIS DIAGNOSTIC TEST REVIEW

Systematic Review of the Neers Test and Hawkins-Kennedy Test

Colleen Levinson Grand Valley State University ATH 31 De!e"#er $% &'1&

SAIS DIAGNOSTIC TEST REVIEW

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Context: T(e )ositionin* o+ t(e a!ro"ion )ro!ess o+ t(e s!a),la% t(e !ora!oa!ro"ial li*a"ent% and t(e (ead o+ t(e (,"er,s relative to ea!( ot(er !reate a s)a!e -it(in t(e s(o,lder re*ion re+erred to as t(e s,#a!ro"ial s)a!e.1 T(e s,#a!ro"ial #,rsa% rotator !,++ tendons% t(e #i!e)s #ra!(ii lon* (ead tendon% and t(e *leno(,"eral /GH0 !a)s,le are all lo!ated -it(in t(is s)a!e.1 A red,!tion in t(is s)a!e !an res,lt +ro" any n,"#er o+ di++erent so,r!es s,!( as s,#a!ro"ial #,rsitis% in+la""ation as a res,lt o+ i")ro)er #io"e!(ani!s or tears to t(e rotator !,++ tendons. T(is red,!tion o+ area res,lts in t(e !o")ression o+ t(e anato"i!al str,!t,res lo!ated -it(in t(e s,#a!ro"ial s)a!e.1 T(e !o")ression% or i")in*e"ent% is 1no-n as s,#a!ro"ial i")in*e"ent syndro"e /SAIS0.1 It (as #een re)orted t(at 2234 5 o+ )atients )resentin* -it( s(o,lder )ain are e6)erien!in* s,!( as a res,lt o+ SAIS% "a1in* t(is )at(olo*y t(e "ost +re7,ent !a,se o+ s(o,lder )ain.3 T(ere are "any di++erent intrinsi! and e6trinsi! +a!tors t(at relate to t(e onset o+ SAIS% -(i!( are !o""only t(o,*(t to #e a res,lt o+ re)etitive !onta!t o+ t(e rotator !,++ tendons -it( ot(er anato"i! str,!t,res -it(in in s)a!e. &% 2 T(e intrinsi! +a!tors in!l,de ",s!le overload and -ea1ness% s(o,lder over,se and re)etitive tiss,e "i!rotra,"a% and de*eneration o+ t(e rotator !,++. & T(e e6trinsi! +a!tors in!l,de t(e a!ro"ion s(a)e% GH insta#ility% altered s!a),lot(ora!i! r(yt("% os a!ro"iale% and de*eneration o+ t(e a!ro"io!lavi!,lar /AC0 8oint. & T(ere are t(ree sta*es o+ SAIS% -(i!( involve ede"a% +i#rosis and !onse7,ent tears in t(e rotator !,++ ",s!les.2 T(e +irst sta*e is !(ara!teri9ed #y ede"a and (e"orr(a*e% and t(e se!ond (as evident rotator !,++ +i#rosis asso!iated -it( t(i!1enin* and )artial tears.2 :,ll t(i!1ness tendon tears and r,)t,res alon* -it( str,!t,re !(an*es

SAIS DIAGNOSTIC TEST REVIEW !(ara!teri9e t(e +inal% t(ird% sta*e. 2 In t(e !lini!al settin* dia*nosti! tests are i")ortant #e!a,se t(ey are a +ast and

easy te!(ni7,e to )er+or" in !o")arison to i"a*in* te!(ni7,es.3 D,e to t(e ",ltit,de o+ )at(olo*ies and t(e ina#ility to )al)ate "any )ro#le"ati! str,!t,res t(ere is an in!reased i")ortan!e +or t(ese s)e!ial tests in t(e !lini!al environ"ent.2 T-o !o""only ,tili9ed dia*nosti! tests are t(e Neer Test and t(e Ha-1ins3;ennedy i")in*e"ent test. <ot( o+ -(i!( -ere desi*ned to re)rod,!e t(e sy")to"s o+ SAIS #y !o")ressin* t(e *reater t,#erosity o+ t(e (,"er,s onto t(e a!ro"ion )ro!ess. & T(e ),r)ose o+ t(is syste"ati! revie- is to !o")are t(e Neer Test and t(e ;ennedy3Ha-1ins test in re*ards to t(eir !lini!al val,e -(en dia*nosin* SAIS. Objective: Understandin* t(e dia*nosti! )er+or"an!e o+ t(ese !lini!al tests is vital -(en ,tili9in* t(eir res,lts to dia*nosis a )atient=s s(o,lder )ain. T(e intention o+ t(is syste"ati! revie- is to deter"ine -(et(er t(e Neer Test or ;ennedy3Ha-1ins Test (as a *reater !lini!al si*ni+i!an!e -(en dia*nosin* SAIS. T(is -ill #e deter"ined t(ro,*( an eval,ation o+ e6istin* s!(olarly resear!( on t(e sensitivity% s)e!i+i!ity% and relia#ility o+ ea!( o+ t(e ort(o)edi! s)e!ial tests. T(e "ore sensitive a test is% a *reater val,e% t(e #etter t(e test is at !orre!tly identi+yin* t(e )resen!e o+ t(e )at(olo*y t(e test is intendin* to reveal. T(e "ore s)e!i+i! a test is% a *reater val,e% t(e #etter it is at !orre!tly identi+yin* A test -it( a (i*(er relia#ility is "ore !onsistent -it( re)eatin* t(e sa"e +indin*s o+ a test ,nder identi!al !onditions% eit(er #y one tester or #y a *ro,) o+ testers.

SAIS DIAGNOSTIC TEST REVIEW ata So!rces:

So,r!es )rovidin* in+or"ation on t(e Neer Test% ;ennedy3Ha-1ins Test% and SIS -ere +o,nd t(ro,*( resear!( on >,#?ed% >ro@,est% S>ORTDis!,s% and CINAHL data#ases. T(e 1ey -ords ,sed to +ind arti!les -ere s(o,lder )ain% s,#a!ro"ial i")in*e"ent% Neer Test% Ha-1ins3;ennedy Test% s(o,lder i")in*e"ent syndro"e% s,#a!ro"ial #,rsitis% and rotator !,++ i")in*e"ent. T(e !riterion +or arti!le in!l,sion -as t(at it ",st (ave #een ),#lis(ed in En*lis( and no earlier t(an &'''. T(ere -ere no restri!tions on t(e *ender or a*e o+ t(e )arti!i)ants t(at t(e arti!les )resented in+or"ation on. St!dy Se"ection: T(e +irst !riterion +or in!l,sion in t(is syste"ati! revie- -as t(e #asis t(at t(e arti!le in!l,ded t(e )ro)er dia*nosti! tests in t(eir resear!(. Ne6t% ea!( o+ t(e arti!les in!l,ded ",st (ave )rovided relevant in+or"ation on t(e dia*nosti! val,e o+ t(e ort(o)edi! s)e!ial tests. T(e arti!les t(at )resented resear!( on t(e sensitivity% s)e!i+i!ity% and relia#ility o+ t(ese s)e!i+i! dia*nosti! tools -ere t(e "ain so,r!es o+ in+or"ation ,sed in t(is syste"ati! revie-. ata #xtraction T(e Neer Test and t(e ;ennedy3Ha-1ins Test are #ot( ort(o)edi! s)e!ial tests t(at eval,ate +or SAIS -it(in t(e s(o,lder in t(e !lini!al settin*. Ho-ever% t(ese tests intend to )rovo1e sy")to"s o+ SAIS #y !ond,!tin* di++erent "ove"ents o+ t(e s(o,lder 8oint. T(e Neer Test is !ond,!ted -it( t(e e6a"iner standin* #e(ind t(e )atient -it( one (and sta#ili9in* t(e s!a),la )reventin* any rotation +ro" o!!,rrin* -(ile t(eir ot(er (and #rin*s t(e )atients ar" into )assive a#d,!tion and +le6ion at t(e *leno(,"eral 8oint.&% 3% 2% 4%

SAIS DIAGNOSTIC TEST REVIEW

$% A% B

T(e ;ennedy3Ha-1ins Test is )er+or"ed #y t(e e6a"iner )assively +le6in* t(e

)atient=s el#o- to B'o and )assively a#d,!tin* t(e )atients at t(eir *leno(,"eral 8oint to B'o. &% 3% 2% 4% $% A% B On!e in t(is )osition t(e e6a"iner )assively and +or!e+,lly internally rotates t(e ar". <ot( o+ t(e tests are des!ri#ed as (avin* a )ositive +indin* -(en )ain is eli!ited in t(e s(o,lder re*ion. &% 3% 2% 4% $% A% B Si6 st,dies and one syste"ati! revie- !o")ared t(e dia*nosti! a!!,ra!y o+ t(ese t-o !lini!al dia*nosti! tests. T(e st,dies eit(er !o")ared t(e sensitivities and s)e!i+i!ities o+ t(e test% t(e relia#ilities o+ t(e"% or all o+ t(ese "eas,res. T(e st,dies re)orted )ositive +indin*s +or t(e tests #ased o++ o+ a si"ilar +indin* o+ )ain -it(in t(e s(o,lder alt(o,*( so"e o+ t(e" (ad s)e!i+i! !riteria +or t(e )ain (avin* to #e in t(e anterior s(o,ld re*ion. ?ost o+ t(e st,dies !on+ir"ed t(e )resen!e or a#sen!e o+ SAIS #y te!(ni7,es s,!( as s,r*ery% art(ros!o)y% or ?RI. One st,dy did not assess t(e s(o,lders ,sin* i"a*ery sin!e t(ey -ere 8,st loo1in* +or t(e relia#ility #et-een e6a"iners.3 T(is st,dy -as !ond,!ted #y si6 resear!(ers in -(i!( t(ey (ad !lini!al tests )er+or"ed on 22 over(ead at(letes t(at eit(er )arti!i)ated in s-i""in*% #ea!( volley#all% (and#all% or #ad"inton.3 O+ t(e 22 )arti!i)ants 3' -ere "ale and 12 -ere +e"ale and t(ey (ad an avera*e a*e o+ 1B.4 years.3 T-o te!(ni!ians -ere ,sed +or t(is st,dy -(o #ot( (ad a "a6i"," o+ si6 "ont(s e6)erien!e in t(e !lini!al settin* and t(ey -ere #ot( #lind to t(e res,lts t(e ot(er (ad +o,nd.3 T(is st,dy re!orded a )ositive +indin* +or Neer Test -it( distin!tion #et-een anterior )ain and *eneral s(o,lder )ain +or inter rater relia#ility.3 T(is st,dy +o,nd an a*ree"ent o+ B35 +or anterior )ain -it( t(e Neer Test and a A&5 a*ree"ent -it( t(e ;ennedy3Ha-1ins Test #et-een t(e t-o e6a"iners.3 W(en e6a"inin* t(e ",t,al de)enden!y o+ Neer Test t(ere -as o#served a*ree"ents o+

SAIS DIAGNOSTIC TEST REVIEW

B15 and B 5.3 T(e ;ennedy3Ha-1ins Test (ad o#served a*ree"ents o+ A45 and A25.3 Relia#ility -as e6a"ined #y t-o additional st,dies in!l,ded in t(is syste"ati! revie-. T(e resear!(ers o+ t(e +irst st,dy !ond,!ted t(e ort(o)edi! s)e!ial tests on )atients 2$ o+ -(o" -ere "ale and A -ere +e"ale.4 T(eir )atients ran*ed in a*e +ro" 1A to A3 -it( an avera*e a*e o+ 2'.4 years.4 Ea!( o+ t(ese )atients ,nder-ent s,r*ery to !on+ir" i+ t(ey (ad SAIS )resent or not.4 T(e se!ond st,dy (o-ever ,sed art(os!o)i! "eas,res as t(eir standard o+ dia*nosis +or SAIS.B T(ese resear!(ers (ad 43 )atients -it( a*es ran*in* +ro" &B to $B years o+ a*e )arti!i)ate in t(eir st,dy o+ -(i!( only ' !(ose to ,nder*o t(e art(ros!o)i! ins)e!tion.B <ot( sets o+ resear!(ers )er+or"ed )(ysi!al e6a"inations on t(e )atients d,rin* -(i!( t(ey in!l,ded #ot( t(e Neer Test and ;ennedy3Ha-1ins Test as a )art o+ t(e !lini!al e6a"ination. O+ t(e )atients in t(e +irst

st,dy% t(e s,r*i!al +indin*s revealed t(at 14 o+ t(e" (ad SAIS -(ile t(e se!ond st,dy +o,nd t(ro,*( art(ros!o)y t(at 2 o+ t(e ' )atients (ad SAIS.4 T(e ;ennedy3Ha-1ins Test re)orted -it( 4B5 a*ree"ent in t(e +irst st,dy and -it( B .15 a*ree"ent in t(e se!ond st,dy.4%B T(e Neer Test (ad $15 a*ree"ent in t(e +irst st,dy and t(e se!ond st,dy re)orted t(at t(ey +o,nd a $ .25 a*ree"ent.4%B T(e resear!(ers o+ t(e +irst st,dy re)orted on t(e sensitivity and s)e!i+i!ity o+ #ot( ort(o)edi! s)e!ial tests in addition to t(e relia#ility. T(ey +o,nd t(e sensitivity o+ t(e Neer Test to #e A15 -(ile t(e ;ennedy3 Ha-1ins (ad a sensitivity o+ 435.4 T(e s)e!i+i!ities -ere +o,nd to #e 25 and 4&5 +or t(e Neer Test and ;ennedy3Ha-1ins Test% res)e!tively.4 All o+ t(e re"ainin* st,dies alon* -it( t(e syste"ati! revie- also !o")ared t(e !lini!al s)e!ial tests in re*ards to t(eir sensitivity and s)e!i+i!ity. T(e syste"ati! reviet(at -as !ond,!ted #y t(e t(ree resear!(ers% Al7,anee% Galvin and :a(ey in!l,ded

SAIS DIAGNOSTIC TEST REVIEW in+or"ation +ro" a n,"#er o+ di++erent st,dies t(at eval,ated t(e dia*nosti! val,e o+

SAIS ort(o)edi! tests.& All o+ t(e in!l,ded st,dies ,sed t(e re+eren!e test o+ art(ros!o)y to deter"ine t(e tr,e )at(olo*y t(at t(eir )atients -ere s,++erin* +ro" e6!e)t +ro" one st,dy t(at ,sed s,r*ery to do so.& Si6 o+ t(e st,dies t(at -ere in!l,ded re)orted on t(e ;ennedy3Ha-1ins test -it( t(eir n,"#er o+ )atients totalin* to 1'&B -(ile +ive st,dies in!l,ded t(e Neer Test -it( 11&$ )atients.& :ro" t(e +indin*s o+ t(ese st,dies t(e resear!(ers o+ t(is syste"ati! revie- +o,nd t(at t(e ;ennedy3Ha-1ins (ad a )ooled sensitivity o+ $25 -(ile t(e Neer Test (as a )ooled sensitivity o+ $A5.& T(e syste"ati! revie- also +o,nd )ooled s)e!i+i!ities o+ $5 and A5 +or t(e ;ennedy3Ha-1ins Test and Neer Test% res)e!tively.& In addition% sensitivity and s)e!i+i!ity -ere resear!(ed #y t(e re"ainin* t(ree st,dies. T(e +irst st,dy ,sed ,ltraso,nd i"a*in* as t(eir standard o+ dia*nosis -(ile t(e se!ond set o+ resear!(ers ,sed ?RI as t(eir standard and t(e t(ird *ro,) o+ resear!(ers ,tili9ed SIT.$%2%B SIT is a 1' !! lido!aine in8e!tion into t(e s,#a!ro"ial s)a!e 8,st ,nder t(e a!ro"ion and )atients -(o e6)erien!ed t(e disa))earan!e o+ )ain 3' "in,tes a+ter #ein* in8e!ted -ere identi+ied as (avin* SAIS.B T(is st,dy -as !ond,!ted on 1&' )atients% $& -ere -o"en and 2A -ere "en. Ei*(t3si6 o+ t(ese )atients tested )ositive t(ro,*( SIT +or SAIS.B <ased on t(ese +indin*s t(e resear!(ers +o,nd a sensitivity o+ B&.15 +or ;ennedy3Ha-1ins Test and AA.$5 +or Neer Test.B :or t(e ;ennedy3Ha-1ins Test t(ey +o,nd a s)e!i+i!ity o+ & .'5 and 3'. 5 s)e!i+i!ity val,e +or t(e Neers Test.B T(e resear!(ers o+ t(e se!ond st,dy t(at ,sed ?RI as t(e standard o+ dia*nosis +o,nd a si"ilar s)e!i+i!ity val,e +or t(e Neers Test o+ 3'.'5% #,t t(eir s)e!i+i!ity +or t(e ;ennedy3Ha-1ins Test -as +o,nd to #e a little (i*(er at 2'.'5.2 T(ese resear!(ers (ad

SAIS DIAGNOSTIC TEST REVIEW

&B )atients in t(eir st,dy o+ -(i!( 1B -ere +o,nd to (ave SAIS t(ro,*( t(e ?RI testin*.2 T(irteen o+ t(e )arti!i)ants -ere "ales and 14 -ere +e"ales and t(ey (ad a*es ran*in* +ro" &2 years old to A& years old.2 <ased on t(e )(ysi!al e6a"inations o+ t(e dia*nosti! tests t(e Neers Test (ad a sensitivity val,e o+ 4A.25 -(ile t(e ;ennedy3Ha-1ins (ad a sensitivity val,e o+ $3.$5.2 T(e +inal set o+ resear!(ers !ond,!ted t(eir st,dy on 33 )arti!i)ants +or t(e Neers Test and 31 )eo)le +or t(e ;ennedy3Ha-1ins Test.$ T(e ,ltraso,nd dia*nosti! +indin*s re)orted t(at &B o+ 33 )arti!i)ants +or t(e Neers Test -ere +or SAIS.$ <ased on t(e !lini!al eval,ations t(e Neer=s Si*n (ad a sensitivity o+ 4&.15 and a s)e!i+i!ity o+ '5.$ T-enty3seven o+ t(e 31 )arti!i)ants t(at t(e ;ennedy3Ha-1ins Test -as !ond,!ted on -ere !on+ir"ed )ositive -it( SAIS t(ro,*( ,ltraso,nd i"a*in*.$ ;ennedy3Ha-1ins -as +o,nd to (ave a sensitivity o+ $2.15 and a s)e!i+i!ity o+ '.'5.$ T(e s)e!i+i!ity and sensitivity val,es !al!,lated #y ea!( o+ tests -ere +o,nd relatin* t(e standard dia*nosti! +indin*s +ro" ea!( st,dy to t(e +indin*s +ro" t(e )(ysi!al e6a"ination o+ t(e Neer and ;ennedy3Ha-1ins Tests. T(e sensitivity is t(e a"o,nt o+ tr,e )ositives divided #y t(e tr,e )ositives )l,s t(e +alse ne*atives. SensitivityC//Tr,e >ositve0D/Tr,e >ositive E :alse Ne*ative00. S)e!i+i!ity is very si"ilar to sensitivity #,t it des!ri#es t(e ne*ative +indin*s o+ a test. S)e!i+i!ityC//Tr,e Ne*ative0D /Tr,e Ne*ative E :alse >ositive00. Relia#ility -as !al!,lated #y t(e st,dies in!l,ded in t(is syste"ati! revie- #y relatin* t(e a"o,nt o+ ti"es t(e testers +o,nd a*reea#le +indin*s +or t(e s)e!ial tests. T(e a*ree"ent )er!enta*e is +o,nd #y dividin* t(e total a"o,nt o+ ti"es a test -as !ond,!ted #y t(e a"o,nt o+ ti"es t(ey (ad t(e sa"e +indin*s. Inter tester relia#ility C /Sa"e :indin*s0 D /Sa"e :indin*s E O))osite :indin*s0. ata Synthesis

SAIS DIAGNOSTIC TEST REVIEW T(e inter rater relia#ility o+ t(e Neer Test -as re)orted as $15% A45% B 5% and $ .25 #y t(e resear!( t(at (as #een in!l,ded. T(e lar*e di++eren!e #et-een t(e $15 a*ree"ent and t(e B 5 a*ree"ent "ay #e a res,lt o+ t(e di++erent re!ordin*s o+ a

)ositive test. T(e B 5 -as #ased on a )ositive +indin* #ein* any *eneral )ain eli!ited.3 Also% t(e val,es !o,ld (ave re)orted -it( s,!( a di++eren!e #e!a,se o+ t(e varia#ility in t(e e6a"iners ,sed in ea!( st,dy. One st,dy ,sed testers -(o #ot( (ad a "a6i"," o+ only si6 "ont(s e6)erien!e -(ile anot(er st,dy ,sed e6a"iners -(o (ad 1$ years and A years o+ e6)erien!e.3%4 Overall% t(e Neers Test (as a "ean inter3tester relia#ility o+ A1.A 5. Co")aratively% t(e ;ennedy3Ha-1ins Test (as a "ean inter3tester relia#ility o+ 4A.135 +o,nd #y t(e re)orted val,es o+ 4B5% 4'5% and B .15. T(ese val,es !o,ld di++er so si*ni+i!antly +or t(e sa"e reasons t(at t(e Neers Test varied. I do #elieve t(at t(e o,tlier o+ B .15 "ay (ave #een a res,lt o+ t(is st,dy (avin* 2 o+ ' o+ t(eir )atients )ositive +or SAIS and ;ennedy3Ha-1ins -(ere as anot(er st,dy only (ad 14 o+ )arti!i)ants )ositive +or SAIS.4%B T(is !o,ld (ave "ade it easier +or t(e testers to deter"ine )ositive tests in t(e )atients. T(e ;ennedy3Ha-1ins Test -as +o,nd to (ave sensitivity val,es t(at -ere all si"ilar to ea!( ot(er e6!e)t +or one o,tlier% 8,st as -as +o,nd +or t(e val,es o+ t(e re)orted relia#ility "eas,res. T(e test -as +o,nd to (ave t(e val,es 435% $2.15% 4A.25% B&.15% and $25 +or its sensitivity. T(is *ives t(e ;ennedy3Ha-1ins a "ean sensitivity o+ $2.3&5. T(e sensitivity !o,ld (ave #een so (i*( +or one o+ t(e st,dies #e!a,se o+ t(e standard dia*nosti! test di++ers +ro" all o+ t(e ot(ers. T(is test ,sed t(e SIT "et(od instead o+ i"a*in* or s,r*ery.A T(is !o,ld (ave !a,sed "ore )atients to )resent -it( t(e )resen!e o+ SAIS. T(e sensitivity val,e +o,nd +or t(e Neer Test -as also t(e (i*(est

SAIS DIAGNOSTIC TEST REVIEW

1'

re)orted val,e o+ all o+ t(e st,dies at AA.$5 indi!atin* t(e dia*nosti! standard !o,ld "ore t(an li1ely (ave an e++e!t on t(e sensitivity val,es.A T(e rest o+ t(e st,dies +o,nd a sensitivity val,e o+ 4&.15% $3.$5% A15% and $A5 *ivin* t(e Neer Test a "ean sensitivity o+ $4.$5. T(e Neer Test )resented -it( t(e val,es o+ 25% '5% 3'5% 3'. 5% and A5 +or s)e!i+i!ity *ivin* it a "ean val,e o+ 32. 5. T(e resear!(ers !o,ld (ave )resented -it( s,!( a di++eren!e in val,es #ased on -(at indi!ated to t(e" a )ositive test. So"e o+ t(e tests re)orted t(at anterior s(o,lder )ain -as a )ositive test -(ile ot(ers re)orted t(at *eneral s(o,lder )ain -as a )ositive test. A test -o,ld (ave a lo-er s)e!i+i!ity i+ "ore o+ t(e !lini!al +indin*s -ere !ate*ori9ed as a )ositive +indin* sin!e *eneral )ain -as indi!ative o+ SAIS% yet ,)on !ond,!tion o+ standard dia*nosti! testin* it -as +o,nd t(at t(ese )atients -ere ne*ative +or SAIS. Fet% anterior )ain !o,ld "ore !orre!tly indi!ate SAIS and *ive t(ese resear!(ers a (i*(er val,e o+ s)e!i+i!ity.4 T(e ;ennedy3Ha-1ins Test (ad "ore ,ni+or" res,lts in re*ards to t(e val,es o+ s)e!i+i!ity t(at -ere re)orted in t(e st,dies. T(e val,es -ere +o,nd to #e 425% '5% 2'5% & 5% and $5 *ivin* t(e test a "ean o+ 2$.&5. T(e res,lts !o,ld di++er #ased on -(at "et(od -as ,sed as t(e dia*nosti! standard +or ea!( st,dy -(et(er t(at #e ?RI% ,ltraso,nd% SIT% or s,r*ery. Conc"!sion: T(e Neer test and t(e Ha-1ins3;ennedy test are )o),larly ,sed dia*nosti! tools in t(e !lini!al settin* +or t(e identi+i!ation o+ SAIS. ?any di++erent st,dies and resear!(ers (ave eval,ated t(ese t-o ort(o)edi! s)e!ial tests in order to deter"ine t(eir ,se+,lness in re*ards to t(eir sensitivity% s)e!i+i!ity% and relia#ility. T(e +indin*s o+ t(is syste"ati! revie- +o,nd t(at overall t(e Ha-1ins3;ennedy test -as less sensitive test

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-(en !o")ared to t(e Neer Test in re*ards to t(eir !al!,lated "ean val,es o+ $2.3&5 and $4.$5 res)e!tively. T(is indi!ates t(at t(e Neer Test is #etter at identi+yin* a )ositive res,lt +or t(e SAIS -(en SAIS is )resent in t(e s(o,lder t(at is #ein* tested. Ho-ever% t(e val,es +or t(e sensitivity +or #ot( o+ t(e tests are !lose to ea!( ot(er and ea!( are val,es t(at re)resent t(e tests as #ot( #ein* ,se+,l -(en )redi!tin* t(e )resen!e o+ SAIS in a )atients -it( s(o,lder )ain. Ho-ever% #ot( o+ t(ese tests are not ,se+,l tests to #e ,sed in t(e !lini!al settin* -(en r,lin* o,t t(e )resen!e o+ SAIS in )atients )resentin* -it( s(o,lder )ain. T(is is )roven t(ro,*( t(e val,es +o,nd +or t(e s)e!i+i!ity o+ t(e tests. T(ro,*( t(is syste"ati! revie- it -as )resented t(at t(e Neer Test (as a "ean s)e!i+i!ity o+ 32. 5 and t(e ;ennedy3Ha-1ins Test (as a "ean s)e!i+i!ity o+ 2$.&5. <ased on t(e avera*e s)e!i+i!ity it !an #e !on!l,ded t(at t(e Ha-1ins3;ennedy test is t(e "ore ,se+,l test to ,se -(en r,lin* o,t t(e )resen!e o+ SAIS in )atients -it( s(o,lder )ain. Alt(o,*( t(e test (as a *reater s)e!i+i!ity t(an t(e Neers Test it is still not a ,se+,l dia*nosti! tool to deter"ine t(e tr,e a#sen!e o+ SAIS #ased on its lo- val,e o+ s)e!i+i!ity% -(i!( is not even '5. Ho-ever% t(e ;ennedy3Ha-1ins Test is a ,se+,l dia*nosti! tool in re*ards to its relia#ility. It -as !al!,lated #y t(e re)orted val,es o+ inter3tester relia#ility to (ave a "ean val,e o+ 4A.135 -(i!( indi!ated t(at it (ave a *ood re)rod,!i#ility #et-een di++erent testers. It is a *ood test at #ein* relia#le to +ind t(e sa"e val,es no "atter -(o is testin* t(e )atient t(at is )resentin* -it( s(o,lder )ain. Alt(o,*( t(e ;ennedy3Ha-1ins (as a *ood val,e o+ relia#ility it is not as relia#le as t(e Neers Test% -(i!( -as !al!,lated to (ave a relia#ility val,e o+ A1.A 5. T(is indi!ates t(at t(e Neers Test is "ore li1ely to )rod,!e t(e sa"e +indin*s #y ",lti)le e6a"iners t(an t(e ;ennedy3Ha-1ins Test is.

SAIS DIAGNOSTIC TEST REVIEW <ot( o+ t(ese ort(o)edi! s)e!ial tests s(o,ld !ontin,e to #e ,sed in t(e !lini!al settin* -(en )atients )resent -it( s(o,lder )ain in order to identi+y t(e )resen!e o+ t(e

1&

SAIS. Alt(o,*(% it is not a ,se+,l indi!ator at r,lin* o,t SAIS it -ill assist !lini!ians in )redi!tin* t(at a )atient is s,++erin* +ro" t(e )at(olo*y. <ased on t(e !lini!al +indin*s it is i")erative t(at t(e !lini!al e6a"iners re+er t(e )atients on +or de+initive i"a*ery testin* to +ind a dia*nosis o+ t(e !a,se o+ t(e )atient=s s(o,lder )ain.

References: 1. Star1ey C% <ro-n S% Ryan G. Examination of Orthopedic and Athletic Injuries. >(iladel)(ia% >aH :A Davis CoI &'1'. &. Al7,naee ?% Galvin R% :a(ey T. Dia*nosti! a!!,ra!y o+ !lini!al tests +or s,#a!ro"inal i")in*e"ent syndro"eH a syste"ati! revie- and "eta3analysis.

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3. 2. . 4.

$. A. B.

Archives of Physical Medicine and Rehabilitation. &'1&IB3H&&B3&34. Vind ?% <o*( S% Larsen C% ;n,dsen H% SJ*aard ;% G,,l3;ristensen <. Inter3 e6a"iner re)rod,!i#ility o+ !lini!al tests and !riteria ,sed to identi+y s,#a!ro"ial i")in*e"ent syndro"e. BM Open. &'11I1H13A. Silva L% Andre, G% ?,no9 >% et al. A!!,ra!y o+ )(ysi!al e6a"ination in s,#a!ro"ial i")in*e"ent syndro"e. Rheumatolo!y. &''BI2$H4$B34A3. <ea,dre,il G% Ni9ard R% T(o"as T% et al. Contri#,tion o+ !lini!al tests to t(e dia*nosis o+ rotator !,++ diseaseH a syste"ati! literat,re revie-. oint Bone "pine. &''BI$4H1 31B. ?i!(ener L% Wals-ort( ?% Do,1as W% ?,r)(y ;. Relia#ility and dia*nosti! a!!,ra!y o+ )(ysi!al e6a"ination tests and !o"#ination o+ tests +or s,#a!ro"ial i")in*e"ent. Archives of Physical Medicine and Rehabilitation. &''BIB'H1ABA3 1B'3. ;elly S% <rittle N% Allen G. T(e val,e o+ )(ysi!al tests +or s,#a!ro"ial i")in*e"ent syndro"eH a st,dy o+ dia*nosti! a!!,ra!y. #linical Rehabilitation. &'1'I&2H12B31 A. Calis ?% A1*yn ;% <irtane ?% ;ara!an I% Calis H% T,9,n :. Dia*nosti! val,es o+ !lini!al dia*nosti! tests in s,#a!ro"ial i")in*e"ent syndro"e. Annals of the Rheumatic $iseases. &'''I BH2232$. Nanda R% G,)ta S% ;ana)at(i)illai >% Lio- R% Ran*an A. An assess"ent o+ t(e inter e6a"iner relia#ility o+ !lini!al tests +or s,#a!ro"ial i")in*e"ent and rotator !,V inte*rity. European ournal of Orthopaedic "ur!ery % &raumatolo!y. &''AI1AH2B 3 ''.