Document Detail

Clinical predictors of a positive response to guided diagnostic block into the subacromial bursa.
MedLine Citation:
PMID:  23047472     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the accuracy of combinations of clinical examination findings for predicting a positive response to injection of local anaesthetic into the subacromial bursa.
DESIGN: Prospective, cohort, diagnostic validity design.
SUBJECTS: Consecutive patients with shoulder pain recruited from primary care physiotherapy and general medical practices.
METHODS: All subjects underwent a standardised clinical examination (index test) followed by a diagnostic injection of xylocaineTM into the subacromial bursa (reference standard test) performed under ultrasound guidance. Clinical examination variables associated with a positive anaesthetic response (≥ 80% post-injection reduction in pain intensity) were identified (p < 0.20) and diagnostic accuracy was calculated.
RESULTS: Of the 196 subjects who received a subacromial bursa injection, 66 subjects (34%) reported a positive anaesthetic response. Strain injury (adjusted odds ratio (AOR) 2.3), anterior shoulder pain (AOR 2.3) and absence of pain with external rotation at 90º abduction (AOR 3.9) were the strongest clinical predictors of positive anaesthetic response. Clinical prediction model variables demonstrated 100% specificity (3 positive tests) but low sensitivity (maximum 40%) for a positive anaesthetic response. Combinations of 9 other clinical variables also demonstrated 100% specificity (7 or more positive tests), and improved sensitivity (95 to 100%) for a PAR compared with clinical prediction model variables when less than two findings were present.
CONCLUSION: Combinations of these clinical tests may assist the clinician to differentiate subacromial pain from other shoulder conditions and guide selection of targeted pain management interventions. Additional diagnostic tests may be required when clinical criteria are not satisfied.
Angela Cadogan; Mark Laslett; Wayne Hing; Peter McNair; Stephen Taylor
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of rehabilitation medicine     Volume:  44     ISSN:  1651-2081     ISO Abbreviation:  J Rehabil Med     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-10     Completed Date:  2013-01-18     Revised Date:  2014-05-30    
Medline Journal Info:
Nlm Unique ID:  101088169     Medline TA:  J Rehabil Med     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  877-84     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Anesthetics, Local / administration & dosage,  therapeutic use*
Injections, Intra-Articular / methods*
Lidocaine / administration & dosage,  therapeutic use*
Middle Aged
Pain Management / methods
Pain Measurement
Prospective Studies
Shoulder Joint / ultrasonography
Shoulder Pain / diagnosis,  drug therapy*
Treatment Outcome
Ultrasonography, Interventional / methods
Young Adult
Reg. No./Substance:
0/Anesthetics, Local; 98PI200987/Lidocaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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