EBP- An Examination of Special Tests for the Shoulder Module 4 Questions

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1 EBP- An Examination of Special Tests for the Shoulder Module 4 Questions Question 51 The Active Compression test using pain or a click as a positive test indicator provides a more accurate diagnosis than using pain alone as the positive test indicator when assessing glenoid labral lesions of some type in the general population. Question 52 Which positive test indicator for the supine Crank test displayed better specificity when assessing the glenoid labral lesions of some type in the general population? Pain Pain or a click Apprehension Weakness Question 53 The Active Compression test will correctly diagnose a glenoid labral lesion of some type in the general population % of the time Question 54 The Active Compression test will correctly rule out a glenoid labral lesion of some type in the general population % of the time Page 1 of 12

2 Question 55 Comparing the diagnostic values of the 13 physical examination tests used in assessing the glenoid labral lesions of some type in the general population, which five tests had diagnostic accuracy data available? Anterior Slide Test, Crank Test, Gerber Lift Off Test, Hawkins & Kennedy Impingement Test, Speed Test Active Compression, Biceps Long Head Test, Gerber Lift Off Test, Jobe Test, Relocation Test Apprehension Test, Crank Test, Gilcreest Test, Speed Test, Yergason Test, Gilcreest Test, Hawkins & Kennedy Impingement Test, Jobe Test, Relocation Test Question 56 Comparing the diagnostic values of the 13 physical examination tests when assessing the glenoid labral lesions of some type in the general population, which diagnostic test has the lowest specificity? Biceps Long Head Tendon Palpation Test Question 57 When assessing glenoid labral lesions of some type in the general population, which test had the greatest positive likelihood ratio? Release Test Apprehension Test Question 58 When assessing glenoid labral lesions of some type in the general population, which test proved to be the most sensitive test and had the lowest negative likelihood ratio? Anterior Slide Test Page 2 of 12

3 Question 59 Which two tests can be used in combination with a Gilcreest test to provide the most appropriate approach to diagnosing a glenoid labral lesion of some type in the general population? Release Test and Jobe Test Apprehension Test and Anterior Slide Test Gerber Lift Off Test and Release Test Apprehension Test and Release Test Question 60 SLAP lesion stands for superior labral from anterior to prone lesion. Question 61 A Type III SLAP lesion is when the superior labrum has a vertical tear analogous to a buckethandle tear in the meniscus of the knee. The remaining rim of labral tissue is well anchored to the glenoid, and the biceps tendon anchor is intact. Question 62 Which test has the greatest sensitivity in the comparison of 6 physical examination tests used in the diagnosis of any SLAP lesion in the general population? Relocation Test Question 63 Which test has the greatest specificity in the comparison of 6 physical examination tests used in the diagnosis of any SLAP lesion in the general population? Relocation Test Page 3 of 12

4 Question 64 Which test has the greatest diagnostic accuracy in the comparison of 6 physical examination tests used in the diagnosis of any SLAP lesion in the general population? Relocation Test Question 65 Which test has the most desirable positive likelihood ratio in the comparison of 6 physical examination tests used in the diagnosis of any SLAP lesion in the general population? Relocation Test Question 66 Which test has the least desirable negative likelihood ratio in the comparison of 6 physical examination tests used in the diagnosis of any SLAP lesion in the general population? Relocation Test Question 67 Although test itself is not very effective, which test using pain as a positive test indicator is the most appropriate test for diagnosing a SLAP lesion of some type in the general population according to the data? Relocation Test Page 4 of 12

5 Question 68 Out of the 9 tests compared for their ability to diagnose Type I or II SLAP lesions in the general population, which test has the greatest sensitivity? Anterior Slide Test Pain Provocation Test Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) Question 69 Out of the 9 tests compared for their ability to diagnose Type I or II SLAP lesions in the general population, which test has the greatest specificity? Anterior Slide Test Pain Provocation Test Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) Question 70 Out of the 9 tests compared for their ability to diagnose Type I or II SLAP lesions in the general population which test has the greatest positive likelihood ratio? Anterior Slide Test Pain Provocation Test Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) Question 71 Out of the 9 tests compared for their ability to diagnose Type I or II SLAP lesions in the general population, which test has the second lowest negative likelihood ratio? Anterior Slide Test Pain Provocation Test Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) Page 5 of 12

6 Question 72 Out of the 9 tests compared for their ability to diagnose Type I or II SLAP lesions in the general population, which test shows the least specificity? Anterior Slide Test Pain Provocation Test Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) Question 73 An active compression test using pain as a positive test indicator can be used in combination with which two tests to diagnose Type I or II SLAP lesions in the general population? Hawkins and Kennedy Impingement Test and Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) Anterior Slide Test and Pain Provocation Test Relocation Test (Anterior, Supine, Held in 90, 110 and 120 of Shoulder Abduction) and Yergason Test Pain Provocation Test and Yergason Test Question 74 Considering specificity, the Active Compression test accurately rules out the presence of a Type I or II SLAP lesion only 50% of the time. Question 75 The typical Anterior Relocation Test version and the shoulder held at 90, 110 and 120 of versions compared for the diagnosis of Type II SLAP lesions both have positive likelihood ratios below 1 and negative likelihood ratios above 1 indicating that both tests can be relied upon. Question 76 Comparing 14 tests, the Biceps Tension test with pain as a positive test indicator, has proven to be the most appropriate test for diagnosing a Type II SLAP lesion in the general population. Which test is the demonstrated the second greatest sensitivity? Hawkins & Kennedy Impingement Whipple Test Apprehension Test (Anterior, Supine) Page 6 of 12

7 Question 77 Comparing 14 tests, the Biceps Tension test did not demonstrate greatest specificity when diagnosing a Type II SLAP lesion in the general population. Which two tests are the most specific? Anterior Slide Test and Biceps Load Test Crank Test (Upright, Held in 160 of Shoulder Flexion) and Pain Provocation Test Anterior Slide Test and Yergason Test Pain Provocation and Yergason Test All of the above Question 78 Which test has the greatest sensitivity for diagnosing Type II, III or IV SLAP lesions in the general population? Biceps Long Head Tendon Palpation Crank Test (Supine) (with Biceps Palpation) Question 79 Which test has the greatest specificity for the diagnosis of Type II, III or IV SLAP lesions in the general population? Biceps Long Head Tendon Palpation (with Biceps Palpation) Crank Test (Supine) Question 80 Which test has the greatest positive likelihood for its ability to diagnose Type II, III or IV SLAP lesions in the general population? Biceps Long Head Tendon Palpation (with Biceps Palpation) Crank Test (Supine) Question 81 The Yergason test proved to have low sensitivity; therefore it provides a good indication that the patient does not have a Type II, III or IV SLAP lesion. Page 7 of 12

8 Question 82 Based on the values at hand, it appears that no test is appropriate for diagnosing a Type II, III or IV SLAP lesion in the general population. However, a Yergason with biceps palpation and pain as a positive test indicator is appropriate for ruling out a SLAP lesion of this type. Question 83 The Relocation test with apprehension can accurately diagnose a Bankart Lesion. Question 84 Both Bankart and Hill-Sachs lesions involve the posterior labrum. Question 85 Using pain as the positive test indicator, the Crank test, according to Liu, Henry and Nuccion (1996), is performed in which position when diagnosing a glenoid labral lesion of some type in a patient population under the age of 40? Crank Test in an upright position with the shoulder held in 90 of abduction Crank Test in supine with the shoulder held in 90 of abduction Crank Test in an upright position with the shoulder held in 160 of abduction Crank Test in supine with the shoulder held in 160 of abduction Question 86 According to the findings of Liu, Henry and Nuccion (1996), the Crank Test performed on a glenoid lesion of some type in a patient population under the age of 40, showed low sensitivity and specificity. This results in a poor and inconclusive positive and negative likelihood. Question 87 Which test had perfect specificity but the lowest sensitivity, only correctly diagnosed a Type II SLAP lesion in the midst of a concomitant injury 18% of the time in a younger population (<40years of age)? Compression Rotation Test Biceps Load II Test Apprehension Test Page 8 of 12

9 Question 88 Which test with pain or clicking as a positive test indicator was the most sensitive test, had one of the higher positive likelihood ratios, and had the lowest negative likelihood ratio, but was not one of the more specific tests when diagnosing a Type II SLAP lesion with a concomitant injury present in a younger population (<40years of age) population? Compression Rotation Test Biceps Load II Test Apprehension Test Question 89 A supine or upright Crank test was found to have a negative likelihood ratio of 2 in a younger (<40years of age) population indicating that a patient with a negative test is 2 times more likely to have a Type II, III or IV SLAP lesion than one who tests positive. Question 90 The Active Compression test performed with the shoulder held in 160 of abduction and using pain as a positive test indicator had a better specificity, positive and negative likelihood ratio than the Crank Test. However, it only correctly diagnoses a Type II, III or IV SLAP lesion 35% of the time in a younger population (<40years of age) population. Question 91 Comparing the diagnostic values found for the evaluation of physical examination tests used to assess Type II, III or IV SLAP lesions in a younger (<40years of age) test population, it appears that no test is appropriate for diagnosing a Type II, III or IV SLAP lesion in a younger population. Page 9 of 12

10 Question 92 Kim et al. (2005) provided some data for the diagnosis of a posteroinferior labral lesion with a Jerk test in a younger (<40 years of age) population. They reported the Jerk test using pain as the positive test indicator had a. a. 73% sensitivity and 98% specificity b. 98% sensitivity and 73% specificity c positive likelihood ratio and 0.28 negative likelihood ratio d positive likelihood ratio and 0.36 negative likelihood ratio e. A & C f. B & C g. A & D h. B & D Question 93 Considering the diagnostic values available for the evaluation of physical examination tests, it appears that a Jerk Test using pain as the positive test indicator is an appropriate test for diagnosing posteroinferior labral lesions in a younger (<40 years of age) population. Question 94 The Crank test performed in an upright position with the shoulder held in 160 of abduction and using a click as the positive test indicator can properly diagnose superior labral lesions in a younger (<40 years of age) population 87% of time. Question 95 Comparing the diagnostic values found for the evaluation physical examination tests, which test is appropriate for diagnosing a Type II, III or IV SLAP lesion in a younger (<40 years of age) athletic population that participates in sports with overhead activities? Crank Test (Supine, Held in 160 of Shoulder Abduction) Jerk Test (with Biceps Palpation) All of the above None of the above Page 10 of 12

11 Question 96 Comparing the diagnostic values found for the evaluation physical examination tests using pain as a positive indicator, which test can be helpful for ruling out a Type II, III or IV SLAP lesion in a younger (<40 years of age) athletic population that participates in sports with overhead activities. Crank Test (Supine, Held in 160 of abduction) Jerk Test (with Biceps Palpation) All of the above None of the above Question 97 Comparing the diagnostic values found for the evaluation of physical examination tests, which test is appropriate for diagnosing posteroinferior labral lesions in a younger (<40 years of age) athletic population that participates in sports with overhead activities. Crank Test (supine held in 160 of abduction) Jerk Test (with Biceps Palpation) All of the above None of the above Question 98 Comparing the diagnostic values found for the evaluation physical examination tests using a click as a positive test indicator, which test is appropriate for diagnosing superior labral lesions in a younger (<40 years of age) athletic population that participates in sports with overhead activities. Crank Test (supine held in 160 of abduction) Jerk Test (with Biceps Palpation) All of the above None of the above Question 99 When considering Type II SLAP lesions, the Biceps Tension test had better sensitivities, positive likelihood and negative likelihood ratios than the Compression Rotation Test in an older population. It also outperformed the Active Compression Test on all these diagnostic measures in that same older population. Page 11 of 12

12 Question 100 When considering the diagnosis of any glenoid labral lesion in the general population, which test is the most reliable? Active Compression test Crank test (Supine) Yergason test (with Biceps Palpation) Anterior Slide test Page 12 of 12