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Internal rotation resistance strength test: A new diagnostic test to differentiate intra-articular pathology from outlet (Neer) impingement syndrome in the shoulder

Zaslav KR

Abstract
This prospective study introduces a new sign to differentiate between outlet impingement and non-outlet (intra-articular) causes of shoulder pain in patients with positive impingement sign: the internal rotation resistance strength test (IRRST). It was hypothesized that positive test results are predictive of non-outlet impingement, whereas negative test results confirm outlet impingement. A prospective comparison between IRRST and arthroscopic findings of 115 consecutive patients showed the test to be highly accurate in differentiating between these two diagnoses (positive predictive value 88%, negative predictive value 96%, sensitivity 88%, specificity 96%, and accuracy 94.5%). The IRRST, in conjunction with impingement and apprehension signs, adds to our armamentarium of tests that distinguish between subacromial outlet impingement and intra-articular forms of pathology.


Test Description:

The IRRST is performed in the standing position with the examiner positioned behind the patient. The arm is positioned in 90 of abduction in the coronal plane and approximately 80 of external rotation. A manual isometric muscle test is performed for external rotation and then compared with one for internal rotation in the same position

If a patient with a positive impingement sign has good strength in external rotation in this position and apparent weakness in internal rotation, the IRRST result is considered positive. Because this is a test of relative weakness in a pathologic shoulder, strength is not compared with the contralateral normal arm.

Link to Original Article

at the side or outer aspect
'key-hole' surgery. Surgery performed via small incisions, using special instruments and a viewing scope..
moving of a body part away from the central axis of the body
References
J Shoulder Elbow Surg 2001;10:23-7



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Tags: [Clinical] [ Impingement] [View tag cloud]

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