The validity and accuracy of clinical tests used to detect labral pathology of the shoulder – A systematic review

Wendy Munro, Raymond Healy

This review systematically evaluates the evidence for the accuracy of tests used to detect labral pathology of the shoulder with reference to study quality and key biases.  Databases were searched to identify 15 studies evaluating 15 clinical tests for labral pathology against Magnetic Resonance Imaging MRI or surgery. Methodological quality was assessed as well as likelihood ratios and true positive rates against false positive rates in receiver operator characteristic plots and summary receiver operator curves.

Probable overestimation of accuracy was caused by use of case control design, verification bias and use of a lesser reference standard. Six accurate tests; Biceps Load I, Biceps Load II, Internal Rotation Resistance, Crank, Kim and Jerk tests were identified from high quality single studies in selected populations. Subgroup analysis identified varying results of accuracy in the Crank test and the Active Compression (AC) test when evaluated in more than one study.

Manual Therapy, 2009, 14(2), 119-130

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