Dynamic ultrasound tests for antero-superior shoulder impingement syndrome: An inter-examiner reliability study

Abstract

Background

The antero-superior impingement syndrome of the shoulder is a condition that is frequently encountered in musculoskeletal practice. Clinical examination tests used to diagnose this pathology are sensitive but not specific. Dynamic ultrasound is of great potential value because this diagnostic tool can be used in addition to the physical examination; it can view the joint in motion and demonstrate impingement. The specificity of Antero-Superior Impingement Syndrome diagnosis may be improved by ultrasonography; however, it is necessary to ascertain that dynamic ultrasound has good reliability in this setting. This study was designed to determine the degree of agreement between examiners for the commonly used tests for the antero-superior impingement syndrome.

Methodology

Forty-one patients with chronic shoulder pain (>2 months) selected consecutively in private chiropractic consultation. These patients were referred within a week to two experienced radiologists who evaluated the positive or negative nature of two dynamic ultrasound tests: the abduction impingement test and the Hawkins–Kennedy test.

Results

The Cohen's kappa value was moderate for the abduction impingement test (κ = 0.52, P < 0.05) and poor for the Hawkins–Kennedy test (κ = 0.36, P < 0.05).

Conclusion

The ultrasound abduction impingement test is reliable when performed in a standardized manner and by experienced practitioners.

Keywords:

• Diagnostic ultrasound
• Shoulder
• Impingement syndrome
• Dynamic ultrasound
• Chiropractic

Acknowledgements

This research was carried out as part of Dr Vincent's Master's degree in Medical Musculoskeletal Ultrasound at the Anglo-European College of Chiropractic, Bournemouth. Dr Vincent wishes to thank Dr Budgie Hussain, D.Med Img., MSc, DMU and Prof Charlotte Leboeuf-Yde, DC, MSc, PhD, supervisors, for their encouragement and guidance while preparing and writing this dissertation, and to thank the Institut Franco-Européen de Chiropratique (IFEC) for giving him the opportunity to undertake this Master degree, and to thank the Anglo-European College of Chiropractic for permission to publish this paper.