Reliability of Common Provocative Tests for Shoulder Tendinitis

Objective: Accurate and reliable shoulder tendinopathy examination maneuvers are essential for diagnosing and treating shoulder pain; however, studies have reported varying results as to the accuracy of common maneuvers. Thus, data from a large, cross-sectional study were used to systematically quantify the reliability and accuracy of clinical diagnostic tests. Methods: Baseline data from the WISTAH cohort study were used to evaluate inter-tester reliability and accuracy of common provocative shoulder examination tests compared with a case definition of shoulder tendinitis. Results: Inter-tester reliability showed reliable consistency between providers with kappa coefficients between 89.5% and 94.8% for all tests. However, sensitivity was generally poor (3.0% to 60.6%). Specificity was consistently high (96.2% to 99.6%). Conclusion: Common shoulder provocative tests show low sensitivity but high specificity, which implies that the primary utility of examination maneuvers is for their negative predictive values.