Jun 2026· International Journal of Research in Orthopaedics· 0 citations· 29 references
Abstract
Background: Subacromial impingement syndrome (SIS) is a leading cause of shoulder pain, accounting for nearly half of all shoulder complaints. Accurate diagnosis is essential, yet challenging due to anatomical complexity and overlapping symptoms. While physical examination (PE) remains crucial, magnetic resonance imaging (MRI) offers superior soft tissue assessment. This study aimed to evaluate the diagnostic accuracy of specific PE tests for SIS in comparison with MRI.
Methods: A cross-sectional study was conducted on 38 patients with shoulder pain presenting to the Department of Orthopaedics, Era’s Lucknow Medical College and Hospital, Lucknow, from May 2022 to May 2024. Patients underwent a series of PE manoeuvres including Passive abduction, Neer, Hawkins, Yocum, Jobe, Patte, Gerber, and Resisted abduction tests. MRI of the symptomatic shoulder was performed within five days of PE and interpreted by a blinded radiologist. Diagnostic performance of each PE test was evaluated using MRI as the reference standard.
Results: The mean participant age was 48.6 years; 63.16% were male. SIS was confirmed via MRI in 55.26% of participants. Among the PE tests, Passive abduction demonstrated the highest accuracy (68.42%), with sensitivity 72.00% and specificity 61.54%, and was the only test with statistically significant correlation to MRI (p=0.0448). Other tests such as Hawkins, Yocum, and Neer showed high sensitivity but lower specificity. The Patte test had the lowest diagnostic accuracy.
Conclusions: The Passive abduction test was the most reliable for diagnosing SIS. While some tests showed reasonable sensitivity, low specificity limited their overall accuracy. PE remains valuable but is best used in conjunction with MRI for optimal diagnosis.
Background: Subacromial bursitis is a frequent cause of shoulder pain and functional disability and is commonly associated with rotator cuff pathology. Accurate imaging is essential for diagnosis. Ultrasonography is widely used for its accessibility and cost-effectiveness compared with magnetic resonance imaging (MRI), which is considered the gold standard for detailed soft tissue assessment. Aim: This study aimed to determine the diagnostic accuracy of ultrasonography in detecting subacromial bursitis using MRI as the reference standard and to assess its association with demographic and clinical factors. Methods: This cross-sectional diagnostic accuracy study was conducted in the Department of Diagnostic Radiology, Mayo Hospital, Lahore, Pakistan, from January 2025 to January 2026. A total of 134 patients aged 20-60 years with clinically suspected subacromial bursitis were included through non-probability consecutive sampling. All patients underwent ultrasonographic examination followed by MRI of the shoulder on the same day. The sample size was calculated based on an anticipated specificity of 77.8%, an expected disease prevalence of 70%, a 95% confidence level, and a 13% absolute precision. Diagnostic performance parameters, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, were calculated using MRI as the reference standard. Statistical analysis also included odds ratio, stratification, normality testing, and chi-squared test for association. Results: Ultrasonography demonstrated a sensitivity of 76.3%, a specificity of 82.9%, a PPV of 91%, an NPV of 60.7%, and an overall diagnostic accuracy of 78.4% in detecting subacromial bursitis. A strong association was observed between ultrasound and MRI findings for subacromial bursitis (OR=15.68; 95% CI: 6.10-40.28; p<0.001), with moderate agreement between both modalities (Cohen's kappa=0.54). The prevalence and severity of subacromial bursitis and associated rotator cuff pathologies increased with age. Stratified analysis showed higher ultrasound sensitivity in younger patients (≤40 years), whereas specificity was higher in older patients (>40 years). Conclusion: Ultrasonography demonstrated good diagnostic accuracy in detecting subacromial bursitis when compared with MRI. Its high PPV and moderate agreement with MRI findings support its use as an initial imaging modality for the evaluation of suspected subacromial bursitis. An increase in subacromial and associated rotator cuff abnormalities was observed with age. Ultrasonography provides a practical, accessible, and cost-effective imaging option, particularly in resource-limited settings. However, MRI should be considered in equivocal cases or when clinical suspicion persists despite a negative ultrasound examination.
Muqaddas Sana, Jawairia Arif, Muhammad Umair et al.· Cureus· 0 citations
USG provides improved detection of osteophytes and offers additional information on soft-tissue and early structural changes in knee OA and serves as a valuable, accessible adjunct to conventional radiography for comprehensive evaluation and early diagnosis of knee OA.
R. Rajkumar, E. D. K. Naidu, Gowthaman Nambiraj et al.· Journal of Clinical and Diag...· 0 citations
Background: Frozen shoulder (FS) is characterized by pain and progressive loss of shoulder range of
motion and is commonly diagnosed by history and physical examination. However, the structural basis of key physical
examination findings remains incompletely defined. Recent studies have focused on rotator interval (RI) as a clinically
important contributor of stiffness in the FS, highlighting the need to understand the relationship between clinical
examination and arthroscopic findings for better diagnostic reasoning.
Objective: The aim of this scoping review was to map the clinical examination findings against the
arthroscopic evidence of RI and related capsuloligamentous involvement in FS, and to identify gaps in non-invasive
diagnosis.
Methods: A structured review was performed from the database inception through January 2026
according to the Joanna Briggs Institute methodology and reported in accordance with the PRISMA Extension for
Scoping Reviews. PubMed and the Cochrane Library were searched. Eligible studies were charted according to
clinical examination findings, arthroscopic or imaging findings, anatomical target, and relevance to the review
objectives. Findings were synthesized descriptively.
Results: Fifteen evidence sources were included. Passive external rotation loss, capsular-pattern
restriction, internal rotation limitation, hand-behind-back restriction, and coracoid-region pain showed plausible links
with rotator interval, coracohumeral ligament, and capsular pathology. Direct diagnostic accuracy evidence was
limited.
Conclusion: Key clinical findings may reflect rotator interval and capsular pathology in frozen
shoulder, but no single test is definitive. A structured clinical examination with selective imaging may improve noninvasive diagnosis.
Akshitha Rajashekar, Vijayakumar Palaniswamy, Kamar Jahan et al.· International Journal of Dru...· 0 citations
Introduction: Lateral Epicondyle Tendinopathy (LET), or 'Tennis Elbow', is a common
musculoskeletal condition affecting athletes and individuals engaging in repetitive movements of
the common extensor tendon (CET). Ultrasonography (US) is a popular, cost-effective and
non-invasive imaging modality to assess the elbow for LET. Several characteristic US findings
have been reported, but there is no established consensus for which are best diagnostic for LET.
We systematically reviewed the published literature for the diagnostic accuracy (sensitivity and
specificity) of US for LET.
Methods: The PubMed database was searched systematically to identify relevant articles
published from inception to 29th June 2026. The inclusion criteria involved studies investigating the
diagnostic accuracy of US findings in LET against a reference standard, e.g. clinical examination
or magnetic resonance imaging (MRI). Excluded studies were those lacking diagnostic outcome
data or those combining imaging modalities in calculating diagnostic accuracy. Sensitivities and
specificities were extracted from the studies.
Results: In total, 147 records were identified and 11 studies were included in this review following
screening (Figure 1). Tendon thickening of ≥ 4.85 mm demonstrated the highest sensitivity
(90.5%), whilst ≥ 4.2 mm was the most specific (95.2%). Neovascularisation assessment via colour
Doppler demonstrated superior sensitivities (57–95%) and specificities (88–100%) when
compared to power Doppler. When assessing tendon elasticity, shear-wave elastosonography
(SWE) and grey-scale US displayed superior sensitivities (90.5–100% and 95% respectively)
compared to compression sonoelastography (SEL). However, all three US techniques confirmed
elasticity changes are highly specific for LET.
Conclusion: The US findings of tendon thickening, neovascularisation and tendon elasticity
changes have high sensitivities and specificities for LET. Other signs, such as cortical irregularities
and tendon tears, varied in their diagnostic accuracies. However, these characteristic US findings,
alongside a patient history and clinical examination, can prove useful in the overall diagnostic
context of LET.
Muhammad Umer, Rifat Hassan, Hozefa Dahodwala et al.· SVOA Orthopaedics· 0 citations
To assess the accuracy of physical examination tests for knee effusion using ultrasound (US) as the reference standard, and to explore whether BMI affects test performance.
Consecutive consenting patients with knee pain were recruited from an academic Rheumatology clinic. Each had a knee US and clinical exam, including inspection, bulge sign (BS), balloon/cross-fluctuance (CF), and patellar tap (PT) tests by an experienced rheumatologist. The sonographer was blinded to the clinical findings. Based on published literature, a pathologic knee effusion was defined as a hypoechoic collection measuring >3.2 mm in the lateral recess with quadriceps contraction.[1]
Patients (N=125) had a mean age of 54 + 16 years and 75% were female. Most patients had RA (45%), other inflammatory arthritis (19%), or CTD (14%). Replaced knees (N=4) were excluded. Clinical evidence of effusion was present in 92/246 knees, including 77 with a CF test, either alone (N=42) or in combination with a BS (N=19) or PT (N=16). In 14 knees with a BS alone, 9 were false positive. One knee had a PT alone which was false positive. The prevalence of pathologic knee effusion on US was 35% (87/246). The physical exam (BS, CF &/or PT + for effusion) had moderate sensitivity 71% (95% CI 61, 81), specificity 81% (95% CI 74, 87), PPV 67% (95% CI 57, 77) and NPV 84% (95% CI 77, 89), with an overall accuracy of 78%. False positive results (N=30) were significantly more frequent in patients with BMI > 25 (83%). False negative results occurred mainly with smaller effusions (<6.6 mm). The CF test had the highest agreement (80%) with US (kappa 0.54, p<0.00005) and the best overall performance (ROC area) compared to the BS and PT (p<0.05). The agreement between the physical exam and US was lower if BMI > 25 (kappa 0.44) compared to BMI <25 (kappa 0.64).
The physical exam had moderate diagnostic accuracy for knee effusion. The CF test had the best overall performance in detecting knee effusions in patients with rheumatic diseases, a finding that has not previously been reported. The PT did not add value to the clinical exam in this study. Elevated BMI was associated with reduced accuracy and PPV of the physical exam. Accuracy of knee effusion diagnosis is improved with US, particularly in patients with elevated BMI or small effusions, and is useful for arthrocentesis planning.
[1.] Terslev L. Ultraschall Med 2012;33:E173-E178.
Ahmed Ibrahem, Sarah Cribby, Chris Penney et al.· Journal of Rheumatology· 0 citations
Background: Sacroiliac joint dysfunction is the one of the commonest conditions which leads to low back
pain. However, due to its complex anatomy and biomechanics its diagnosis is quite difficult. Previous
literature although recommended some clinical diagnostic tests but there accuracy is still unclear. Therefore,
the aim of present review was to identify the most reliable clinical diagnostic test tool in order to assess
sacroiliac joint dysfunction.
Methodology: Three databases (PubMed, Cochrane library and PEDRO) was used to search the relevant
articles. Various keywords related to sacroiliac joint dysfunctions and clinical/pain provocation test was used
by using Boolean operators (AND/OR). The full text articles were taken from inception to till 2026. The
included studies methodological quality was checked on the basis of QADAS-2 risk of bias tool.
Results: Eleven studies satisfied the requirements for inclusion. The most often studied tests were those that
provoked pain, such as the thigh thrust, compression, distraction, FABER, and Gaenslen tests. With
sensitivity ranging from 53% to 88% and specificity ranging from 16% to 81%, individual tests showed
inconsistent diagnostic accuracy. With sensitivity ranging from 85% to 91% and specificity ranging from
76% to 82%, clusters of three or more positive provocation tests consistently showed improved diagnostic
accuracy. Motion palpation tests demonstrated higher variability and less diagnostic value. The majority of
the examined studies showed a low-to-moderate risk
Conclusion: There isn't a single clinical test that can accurately identify SIJ dysfunction on its own. Pain
provocation test clusters offer the best diagnostic precision and ought to be used in standard clinical
evaluation. It is necessary to conduct additional high-quality diagnostic accuracy investigations using defined
reference standards.
Arpit Bansal, Pooja Dogra, Nalina Gupta et al.· International Journal of Dru...· 0 citations