Special Test Synopsis

Posted: August 26th, 2021

Special Test Synopsis

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Special Test Synopsis

The particular test in this study will involve discussing the process for conducting a drop arm test. The test looks at pertinent information on the cervical spine or the upper extremity. By definition, a drop arm test is made to help establish whether the patient can maintain humeral joint movements the eccentric contraction as the arm is taken through the complete motion of abduction to adduction (Biederwolf, 2013). The test aims to ascertain if the patient is suffering from any dysfunction within the rotator cuff (Buckup & Grossman, 2008). The discussion explains the complete testing process by highlighting the procedure and the mechanism involved, as well as the expected results.

Procedure

The patient sits on the examination table before the start of the process. In another case, the patient can be made to stand as the test is being performed. During the process, the examiner should remain standing behind the arm under evaluation or by the lateral side of the patient (Buckup & Grossman, 2008). The shoulder of the arm under evaluation is passively abducted by the examiner and moved within 90 degrees level. While in this position, the patient is asked to adduct the arm slowly to their side. In the circumstances that the arm fails to undergo the requested motion, the examiner has to exert a little pressure on the distal forearm while holding the arm at 90 degrees position (Buckup & Grossman, 2008). When the arm falls on the side, there is a possibility of a dysfunctional rotator cuff. Subsequently, when the patient is unable to control the movement of the arm indicates that there is dysfunction in the rotator cuff (Woodward & Best, 2000; Buckup & Grossman, 2008). Notably, this implies that the supraspinatus part may be affected. Whenever weaknesses or instances of implication are detected, indicating the possibility of the dysfunctional rotator cuff, it requires that the patient be assisted in performing adduction motions (Woodward & Best, 2000). If the patient fails to respond to the motion, the examiner should help by having the arm held at 90 degrees, and then slightly exert some pressure on the distal forearm part. In this case, the dysfunctional rotator cuff is detected if the arm of the patient falls on their side.

Mechanism

The following figure shows the mechanism of the drop arm tests.

Figure 1: Drop arm tests mechanism

Figure 1 shows the drop-arm test mechanism. As depicted, the patient is made to perform several adduction and abduction from 90 degrees as the examiner assesses the reaction of the arm. The test is implemented through subluxing the shoulder head to ascertain for weakness or tear within the supraspinatus tendons.

Results

The examiner determines positive tests when it is established that the patient is unable to hold the arm at 90 degrees or control the lowering of the arm. For instance, when the tests begin from 90 degrees abduction, the results are positive if the patient fails to control the affected arm within 90 degrees (Buckup & Grossman, 2008; Woodward & Best, 2000). Sometimes the patient may exhibit pains or no pains at all. As shown in figure 1, the patient feels no pain when the arm is abducted 120 degrees or adducted 60 degrees. However, pain alone is not a positive indicator of the test (Woodward &Best, 2000).  Hence, positive tests are when the patient is unable to control lowering or holding the arm at 90 degrees of abduction.

Evidence (reliability, validity, sensitivity, specificity)

While conducting diagnostic accuracy of shoulder special tests in a cohort study on 15 participants, Jain et al. (2017) explains that the drop arm tests has a specificity of 96% (95% CI = 93%-100%) with sensitivity of 24% (95% CI = 1.79 -2.95) and a likelihood ratio of 6.45% (95% CI=2.25-18.47). On the other hand, its immediate comparison, that is, Job test reported sensitivity of 88% (95% CI =80%-96%) with a specificity of 62% (95% CI = 53% -73%) and a likelihood ratio of 2.30 (95% CI = 1.79-2.95) (Jain et al., 2017). Equally, when the tests were categorized by tear size, the drop arm test reported a sensitivity of 21% (95% CI = 7% – 35%) with a specificity of 96% (95% CI=93%-100%) and a likelihood ratio of about 5.73 (95% CI=1.79-18.36) based on the diagnosis performed on large supraspinatus tears of >= 2 centimeters. Other tests such as Jobe’s test, Neer’s sign, Hawkin’s test and full can test reported similar accuracy level when performed for the same test (Calis et al., 2000). Subsequently, literature reviews on the test show a wide variation in sensitivity and the specificity of special tests (Jain et al., 2017). The variation exhibited in previous studies is attributed to the differences in the patients’ population, reliance on patients undergoing surgery and the heterogeneity of the gold standards applied in measuring the cuff tear, among other uncontrolled factors. Both Jobe’s tests and full can test report a high likelihood ratio (Calis et al., 2000). As such, the results from these tests show that there is a high probability of getting a definite diagnosis for patients with rotator cuff tear compared with patients without the complication.

However, assessing the drop arm tests reveals high specificity and low level of sensitivity. Equally, drop arm tests report a high likelihood ratio. Notably, it is shown that whenever the results of drop arm tests are positive, there are high chances that the patient is suffering from supraspinatus tear (Jain et al., 2017). However, negative tests do not conclusively inform the examiner about the situation in the patient’s condition. Hence, caution should be taken when interpreting the information from the drop arm test to avoid misinterpretation.  At the same time, the examiner should avoid using drop arm tests for screening because it has low sensitivity levels (Calis et al., 2000). Thus, for accuracy, drop arm test should be used in collaboration with other tests when examining the shoulder defects for a patient to ensure reliability, validity and accuracy of the results.

References

Biederwolf, N., E. (2013). A Proposed Evidence-Based Shoulder Special Testing Examination Algorithm: Clinical utility based on a systematic review of the literature. Retrieved on 29^th January 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812837/

Buckup, K. & Grossman, J. (2008). Clinical tests for the musculoskeletal system: examinations, signs, phenomena. Stuttgart New York: Georg Thieme Verlag.

Calis, M. et al. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis 59:44-47.

Jain, N., B. et al. (2017). The diagnostic accuracy of specialized tests for rotator cuff tear: The ROW Cohort Study. AM J Physician Medical Rehabilitation, 96(3): 176-183.

Woodward, W., T. & Best, T., M. (2000). Painful Shoulder: Part 1. Clinical Evaluation. University of Wisconsin Medical School, Madison, Wisconsin, 15; 61(10):3079-3088: https://www.aafp.org/afp/2000/0515/p3079.html