The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature

Robert Cooperstein, Makani Lew

Abstract: Objective: Although it is common to find assertions relating functional leg length inequality (LLI) to pelvic torsion and other states of subluxation, comments and/or data concerning anatomical LLI in this same context are uncommon. This review of the literature synthesizes the evidence on pelvic torsion in relation to anatomical LLI.

Methods: The literature was searched using the PubMed; Manual, Alternative, and Natural Therapy Index System; Allied and Complementary Medicine Database; Cumulative Index to Nursing and Allied Health Literature; and Index to Chiropractic Literature databases for primary studies that related LLI, either artificially created or naturally occurring, to pelvic torsion. Extracted data included natural vs artificial LLI, method of creating or detecting LLI, subject selection, methodology for measuring pelvic torsion, and results.

Results: Nine English-language studies were retrieved published 1936-2004. Seven determined the impact of artificial, transient LLI on pelvic torsion, whereas 2 studied the effect of naturally occurring LLI.

Conclusion: Across varying methodologies for measuring LLI and pelvic torsion, a consistent, dose-related pattern was identified in which the innominate rotates anteriorly on the side of a shorter leg and posteriorly on the side of the longer leg. This finding was contrary to the common assertion that the ilium rotates posteriorly on the side of a short leg and vice versa. Practitioners of manual medicine who derive vectors for intervention based on leg checking procedures should consider the possibility that the direction of pelvic torsion may be variable depending on whether the LLI is of anatomical or functional origin.

Journal of Chiropractic Medicine, Vol 8, Issue 3, Pages 107-118 (September 2009) – abstract

Filed under: Assessment, Hip, Physical examination, Topic review , Leg length inequality, Sacroiliac joint, Torsion, Mechanical, Posture, Ilium

Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review.

Hughes PC, Taylor NF, Green RA

Question: Do clinical tests accurately diagnose rotator cuff pathology?

Design: A systematic review of investigations into the diagnostic accuracy of clinical tests for rotator cuff pathology.

Participants: People with shoulder pain who underwent clinical testing in order to diagnose rotator cuff pathology.

Outcome measures: The diagnostic accuracy of clinical tests was determined using likelihood ratios.

Results: Thirteen studies met the inclusion criteria. The 13 studies evaluated 14 clinical tests in 89 separate evaluations of diagnostic accuracy. Only one evaluation, palpation for supraspinatus ruptures, resulted in significant positive and negative likelihood ratios. Eight of the 89 evaluations resulted in either significant positive or negative likelihood ratios. However, none of these eight positive or negative likelihood ratios were found in other studies. Of the 89 evaluations of clinical tests 71 (80%) did not result in either significant positive or negative likelihood ratio evaluations across different studies.

Conclusion: Overall, most tests for rotator cuff pathology were inaccurate and cannot be recommended for clinical use. At best, suspicion of a rotator cuff tear may be heightened by a positive palpation, combined Hawkins/painful arc/infraspinatus test, Napoleon test, lift-off test, belly-press test, or drop-arm test, and it may be reduced by a negative palpation, empty can test or Hawkins-Kennedy test.

Australian Journal of Physiotherapy 54: 159–170 – full text

“The poor accuracy of clinical tests for rotator cuff pathology could be related to a lack of anatomical validity of the tests or it may be that the close relationships of structures in the shoulder may make it difficult to identify specific pathologies with clinical tests.”

Filed under: Assessment, Physical examination, Shoulder , differential, Review, Rotator cuff; Diagnosis

Special physical examination tests for superior labrum anterior posterior shoulder tears are clinically limited and invalid: a diagnostic systematic review

Calvert, Chambers, Regan et al

Objective

The diagnosis of a superior labrum anterior posterior (SLAP) lesion through physical examination has been widely reported in the literature. Most of these studies report high sensitivities and specificities, and claim to be accurate, valid, and reliable. The purpose of this study was to critically evaluate these studies to determine if there was sufficient evidence to support the use of the SLAP physical examination tests as valid and reliable diagnostic test procedures.

Study Design and Setting

Strict epidemiologic methodology was used to obtain and collate all relevant articles. Sackett’s guidelines were applied to all articles. Confidence intervals and likelihood ratios were determined.

Results

Fifteen of 29 relevant studies met the criteria for inclusion. Only one article met all of Sackett’s critical appraisal criteria. Confidence intervals for both the positive and negative likelihood ratios contained the value 1.

Conclusion

The current literature being used as a resource for teaching in medical schools and continuing education lacks the validity necessary to be useful. There are no good physical examination tests that exist for effectively diagnosing a SLAP lesion.

Journal of Clinical Epidemiology, Volume 62, Issue 5, May 2009, Pages 558-563 – abstract

doi:10.1016/j.jclinepi.2008.04.010

Filed under: Physical examination, Shoulder, Topic review , Diagnostic accuracy, Physical examination, Sensitivity, Shoulder, Superior labrum anterior posterior (SLAP) lesion, Systematic review