At the Nxt Gen Institute of Physical Therapy, we are striving to move the profession forward. One we have done this is through the development of a daily research review on our Facebook page. We are excited to be sharing this clinically relevant information on TheManualTherapist.com as well in our Weekly Research Round-Up...
Differentiating Rotator Cuff Tear from Subacromial Impingement
Nxt Gen PT Evidence: As we promote #GetPT1st, we need to continuously refine our skills in medical screening and differential diagnosis. Within shoulder pathology, we have fairly decent evidence that we can differentiate a full thickness rotator cuff tear from a subacromial impingement through the following cluster diagnoses criteria:
A combination of a + Hawkins Kennedy, + Painful arc and + infraspinatus strength test have a + likelihood ratio of 10.56 for having any degree of subacromial impingement.
A combination of a + Drop arm, + Painful arc and + infraspinatus strength test have a + likelihood ratio of 15.57 for having a full thickness RTC tear.
Clinical Implications: Differentiating subacromial impingement from a rotator cuff tear comes down to a drop arm test. If a drop arm is present, along with a painful arc of motion and infraspinatus strength test, a full thickness tear is likely present.
Better Your Practice: Utilizing appropriate cluster diagnostic criteria, we can improve our clinical reasoning processes.
Park HB, Yokoto A, Gill HS, Rassi GE, McFarland EG. Diagnostic Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome. Journal of Bone and Joint Surgery. 2005: 87; 1446-1455.
Better Understanding of a SLR
Nxt Gen PT Evidence: While the SLR test is commonly taught within DPT curriculum, we have noticed its interpretation is often inconsistent with what the evidence tells us. Research has indicated that a SLR test stretches the L5&S1 nerve roots by 2mm-4mm, so when positive, may indicate an issue at this level. This will occur during the first 70 degrees of flexion. Past 70 degrees of flexion, tension is placed on the sciatic nerve outside of the spinal canal.
Clinical Implications: Interpretation of special tests will obviously influence our clinical decision making. Therefore, we need to know what a test is supposedly testing.
Better Your Practice: A SLR can help us determine neural involvement, and we can hypothesize on current regions of potential involvement based upon the provided information.
Mailesi J, Togay H, Unalan H. The Sensitivity and Specificity of the Slump and the Straight Leg Raising Tests in Patients With Lumbar Disc Herniation. J of Clin Rheum. 2008; 14(2): 87-91.
Interested in learning more through post-graduate education such as Orthopedic Residency, Manual Therapy Fellowship or a niche certification? Visit www.nxtgenpt.com
Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!
Keeping it Eclectic...
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