Shoulder impingement syndrome. How reliable are the commonly used clinical orthopedic tests?

Objective. The aim of this study was the evaluation of the diagnostic accuracy of the commonly used clinical orthopedic tests to detect shoulder impingement syndrome. Methods. We carried out a systematic analysis of the literature from 1978 to 2008 using PubMed database. The quality of the data in each relevant article was determined by examining the study's internal and external validity through Quality Assessment of Diagnostic Accuracy (QUADAS). We included 11 articles from the literature research. Results. The selected literature showed inhomogeneous data, with limited quality in some. There are many different clinical orthopedic tests being used to identify different pathologies of the shoulder or to enable a differential diagnosis of impingement subgroups. The selected literature showed statistical inhomogeneity. The studies presented different inclusion criteria for the patients, which were often not clearly defined. Even the criteria for detecting impingement syndrome were inconsistent. The analysis showed discrepancies between sensitivity and specificity. There are only reliable results available for the frequently used Neer and Hawkins-Kennedy test. The analysis pointed out that no test has adequate screening accuracy in detecting impingement syndrome. A combination of different orthopedic tests can improve the clinical diagnosis. Conclusion. A combination of orthopedic tests can lead to a correct diagnosis. Additional data such as medical history and the use of imaging techniques (sonography, Xray, magnetic resonance imaging) are advisable. Further prospective studies with a consistent format are necessary to evaluate the impingement tests.