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Reliability of Common Provocative Tests for Shoulder Tendinitis

Doxey, Robert, MD, MOH; Thiese, Matt S., PhD, MSPH; Hegmann, Kurt T., MD, MPH

Journal of Occupational and Environmental Medicine: December 2018 - Volume 60 - Issue 12 - p 1063–1066
doi: 10.1097/JOM.0000000000001430

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.

The University of Utah, Rocky Mountain Center for Occupational and Environmental Health, Salt Lake City, Utah.

Address correspondence to: Kurt T. Hegmann, MD, MPH, University of Utah, Rocky Mountain Center for Occupational and Environmental Health, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108 (

Funding provided, in part, by the Centers for Disease Control and Prevention/National Institute of Occupational Safety and Health under award numbers 1 U 01 OH007917-01 and 3TC42OH008414.

Doxey, Thiese, and Hegmann have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2018 by the American College of Occupational and Environmental Medicine