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The purpose of this diagnostic, cross-sectional study, was to determine the predictive value of clinical examination versus ultrasonographic evaluation in rheumatoid arthritis patients, suspected of having rotator cuff disease.

The left and right shoulders of fifty consecutive patients from the rheumatoid clinic were subjected to clinical examination by a senior registrar in the department. Impingement was evaluated using the Neer, Hawkins and posterior impingement tests. The supra-spinatus tendon insertion (Jobe test), infraspinatusteres minor tendon insertions (resisted external rotation) and subscapularis tendon insertion (Gerber lift-off and push-off tests) into the rotator cuff were evaluated for a possible tear. A Professional Sport Sonographer, located in a separate examination room then performed an ultrasonographic evaluation on all of the patients. The clinical results were compared to the ultrasound results, hoping to find a method that will improve our current screening of rheumatoid patients for rotator cuff disease and planning of possible surgical treatment.

A significant difference was found between the clinical and sonographic evaluation of the rotator cuffs. Impingement tests showed a false positive result of 85–89%, while the tests for cuff tears had a false negative value of 87–91% compared to ultrasound evaluation. A total disagreement of 45.8–60% and total agreement of 39.5–54.1% could be explained by the fact the synovitis is the hallmark of rheumatoid disease, which could cause pain without tears or impingement.

The authors conclude that clinical examination of the rotator cuff in patients with rheumatoid disease is unreliable, and that ultrasound examination should form a routine part of the evaluation of all rheumatoid shoulders.

Correspondence should be addressed to: Léana Fourie, CEO SAOA, PO Box 12918, Brandhof 9324 South Africa.