Inter-observer reliability of physical examination in the painful shoulder: supraspinatus tendinopathy

Abstract

Objectives: Our hypothesis is that there is enough concordance in the implementation and interpretation of the orthopaedic maneuvers by expert explorers. The aim of our study was to analyze the inter-observer reliability of special orthopaedic maneuvers aimed at the physical examination of the supraspinatus tendon. Setting: Secondary care; referral hospital for the Region de Murcia (Spain) fifth level of care. Participants: 66 patients, 32 men and 34 women, were explored. The patients included were adults (≥ 18 years), who suffered one-sided omalgia during at least 3 months. Exclusion criteria were: Bilateral shoulder pain, fractures or previous dislocations, osteoarthritis and advanced retractable capsulitis, previous surgeries, less than 3 months of the last shoulder infiltration, cervical-brachialgias or neurological affectation, and the existence of obvious deficiency in the collaboration or understanding of the orders effected by the explorer. Primary and secondary outcome measures: The physical assessment was conducted by two experienced explorers. The drop-arm test, the Jobe empty-can test, the full-can test and shrug sign, were carried out according to the original descriptions. Inter-observer concordance was studied. Results: The highest levels of inter-explorer concordance were found in the drop-arm test (0.799 PABAK with an 84, 62% of agreement). The full-can test and shrug sign showed a good reliability, while the Jobe test presented a moderate reliability. Conclusions: The drop-arm test, empty-can test, full-can test and shrug sign met the minimum criteria of percentage of agreement > 75% and 0.60 inter-observer reliability, by what were considered to be appropriate for their use in physical examination. Therefore, we consider that they are reproducible tests in medical practice for the diagnosis of the pathology of the supraspinatus tendon.