Devitt Chad M, Neely Marlon R, Vanvechten Brian J
Veterinary Referral Center of Colorado-Surgery, Englewood, CO 80110, USA.
Vet Surg. 2007 Oct;36(7):661-8. doi: 10.1111/j.1532-950X.2007.00318.x.
To determine the diagnostic validity of commonly used physical examination maneuvers for shoulder instability.
Retrospective study.
Dogs (n=24) referred for shoulder arthroscopy.
Results of physical maneuvers and arthroscopic findings were recorded and sensitivity, specificity, positive likelihood ratios (LR+), and negative likelihood ratios (LR-) were calculated for each of 4 physical examination test findings for arthroscopic changes in the medial, lateral, cranial, or caudal compartments of the shoulder joint viewed in dorsal recumbency by lateral and craniomedial portals.
Distribution of compartment changes was: medial (17 dogs), caudal (15), cranial (12), and lateral (5). The biceps test had a moderate effect (LR+=9) on post-test probability of cranial compartment changes and a small effect on post-test probability of lateral and caudal compartment changes (LR+=3 and 2.4, respectively). Hyperabduction had a minimal effect and mediolateral instability test had a small effect (LR+=1.64 and 2.68, respectively) on post-test probability of medial compartment changes. Craniocaudal instability test had little to no effect on post-test probability of changes in any compartment.
Physical examination tests evaluated were limited in their ability to predict the type of arthroscopic pathology in this study population.
Clinicians should understand that a diagnostic test performs inconsistently based on prevalence of a condition in a given patient population. The use of likelihood ratios can assist clinicians in determining the probability of intraarticular changes from a group with a differing prevalence than the patient population presented.
