Accuracy of physical examination against magnetic resonance imaging in subacromial impingement syndrome

Abstract

Background: Subacromial impingement syndrome (SIS) is a leading cause of shoulder pain, accounting for nearly half of all shoulder complaints. Accurate diagnosis is essential, yet challenging due to anatomical complexity and overlapping symptoms. While physical examination (PE) remains crucial, magnetic resonance imaging (MRI) offers superior soft tissue assessment. This study aimed to evaluate the diagnostic accuracy of specific PE tests for SIS in comparison with MRI. Methods: A cross-sectional study was conducted on 38 patients with shoulder pain presenting to the Department of Orthopaedics, Era’s Lucknow Medical College and Hospital, Lucknow, from May 2022 to May 2024. Patients underwent a series of PE manoeuvres including Passive abduction, Neer, Hawkins, Yocum, Jobe, Patte, Gerber, and Resisted abduction tests. MRI of the symptomatic shoulder was performed within five days of PE and interpreted by a blinded radiologist. Diagnostic performance of each PE test was evaluated using MRI as the reference standard. Results: The mean participant age was 48.6 years; 63.16% were male. SIS was confirmed via MRI in 55.26% of participants. Among the PE tests, Passive abduction demonstrated the highest accuracy (68.42%), with sensitivity 72.00% and specificity 61.54%, and was the only test with statistically significant correlation to MRI (p=0.0448). Other tests such as Hawkins, Yocum, and Neer showed high sensitivity but lower specificity. The Patte test had the lowest diagnostic accuracy. Conclusions: The Passive abduction test was the most reliable for diagnosing SIS. While some tests showed reasonable sensitivity, low specificity limited their overall accuracy. PE remains valuable but is best used in conjunction with MRI for optimal diagnosis.