Question:I went to see the doctor about a problem with my shoulder. I couldn't really relax enough to get a good test because of the pain. How can they tell what's really wrong?
Answer:There are many clinical tests used by physicians to assess the shoulder joint. Some tests look at the joint itself. Others test muscle strength or weakness. Still other tests help identify problems with the ligaments, cartilage, or tendons. Putting all the tests together along with the history of what happened guides the doctor's diagnosis.
Some tests are more specific than others. Specificity refers to how often the test is positive when there's a true problem. Other tests have greater sensitivity than specificity. Sensitivity shows the ability to show a true negative test. The best test has both high sensitivity and high specificity.
Researchers study clinical tests one by one to measure their specificity and sensitivity. Depending on the problem, they can use X-rays, CT scans, MRIs, or arthroscopy to confirm the findings.
These studies have shown us that pain isn't the best indicator of what's wrong. Apprehension (fear that the shoulder is going to dislocate) is a much better sign of shoulder instability. If you can't relax enough to get a true test result, then the test(s) can be done again under anesthesia. The doctor may also use an arthroscope to look inside the joint while you are sedated. This is the best way to know for sure what's wrong.Adam J. Farber, MD, et al. Clinical Assessment of Three Common Tests for Traumatic Anterior Shoulder Instability. In The Journal of Bone and Joint Surgery. July 2006. Vol. 88-A. No. 7. Pp. 1467-1474.
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