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Comprehensive Assessment of the Shoulder Complex: ACPA Conference Insights

This conference presentation by Stuart Calver covers key subjective exam findings, diagnostic accuracy of orthopaedic tests, and a specialized treatment approach for shoulder issues, including referred pain and nerve root connections. The video demonstrates various clinical tests and their reliability, highlighting the importance of combining tests for accuracy. The presentation also discusses the limitations of individual tests and the challenges in pathognomonic diagnoses. Treatment-based assessments, along with sub-categorization approaches, are emphasized to improve the management of shoulder conditions.

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Comprehensive Assessment of the Shoulder Complex: ACPA Conference Insights

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Presentation Transcript

  1. Assessment of the shoulder complex ACPA conference 9th April 2014 Stuart Calver MSc, Grad Dip Phys, MCSP

  2. Contents • Key findings subjective exam • Shoulder exam video approx 10 mins • Diagnostic accuracy orthopaedic special tests and combination of tests • Stuart’s sub categorisation treatment approach

  3. Referred pain • Nearly all shoulder structures are supplied by the C5 nerve root • Acromioclavicular joint is supplied by C4 thus refers pain to this segment • Watch out for Cloward’s areas

  4. Cloward’s areas

  5. Shoulder assessment video

  6. Diagnostic accuracy individual clinical tests • The use of any single ShPE test to make a pathognomonic diagnosis cannot be unequivocally recommended (Hedegus 2008 & 2012). • Many tests that have high sensitivity (Sn) have poor specificity (Sp) & visa versa, very few tests have Sn & Sp > 80% • Some tests such as apprehension test are beginning to stand the test of time. • Combinations of tests provide better accuracy but only marginally so.

  7. Combination of tests

  8. Reliability of shoulder exam • Pellecchia et al (1996) 91% agreement; kappa=0.88 using Cyriax method of assessment, Cyriax’s schema patho-anatomical classification with nine possible categories. However sample size small n=21 & only 2 assessing therapists used. • Carter et al (2012) used 3 clinical syndromes; pattern 1: impingement, pattern 2: AC joint pain, pattern 3: 7 subcategories including OA, frozen shoulder, cuff tear & instability. 55 physiotherapists arranged in pairs. 80% agreement; kappa=0.66

  9. Treatment based assessment • Unlikely that any test would not compress or stretch adjacent structures • Most orthopaedic tests have high sensitivity but low specificity or visa versa • Investigations used as gold standard (MRI, arthroscopy) have high levels of false positive & negative.

  10. Sub categorisation treatment approach

  11. Any Questions

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