SynthesisThe Physician and sportsmedicine2018
A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review.
Synthesis in The Physician and sportsmedicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05161468 (Bayesian Non-inferiority Trial of Injection Therapies for Acromioclavicular Joint Pain), which is not on this map. Cited by 10 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Bayesian Non-inferiority Trial of Injection Therapies for Acromioclavicular Joint Pain: a Randomized Clinical Trial
Who cites it
10 citing papers in PubMed.
- Risk factors and management of atraumatic distal clavicular osteolysis: A scoping review.Shoulder & elbow · 2026Review
- Comprehensive review of acromioclavicular joint dislocation: anatomy, mechanism, imaging, treatment and rehabilitation-narrative review.Journal of orthopaedic surgery and research · 2026Review
- Ultrasonographic Validity of Clinical Shoulder Impingement Signs in Patients Without Limitation of Motion.Archives of rehabilitation research and clinical translation · 2025Article
- A bibliometric analysis of the 50 most cited articles on acromioclavicular joint reconstruction.Musculoskeletal surgery · 2025Review
- Could a feedback device help manage work-related shoulder disorders?: protocol of a mixed methods pilot study.Pilot and feasibility studies · 2025Article
- External Rotation of the Shoulder against Resistance as a Clinical Sign to Aid in the Diagnosis of Acromioclavicular Injury.Journal of orthopaedic case reports · 2024Article
- Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional midterm outcomes.Clinics in shoulder and elbow · 2024Article
- Current Concepts in Management of Acromioclavicular Joint Injury.Journal of clinical medicine · 2024Review
- Mid- to long-term success rate and functional outcomes of acromioclavicular injections in patients with acromioclavicular osteoarthritis.Clinics in shoulder and elbow · 2023Article
- Treatment of a Failed Type V Acromioclavicular Separation Due to Coracoid Fracture: Revision of Acromioclavicular-Coracoclavicular Reconstruction and Coracoid Fixation.Arthroscopy techniques · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesThe clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology.
methodsA systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities.
resultsThe optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O'Brien's Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O'Brien's Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35).
conclusionNo combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O'Brien's Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint corticosteroid injection may be an appropriate new standard for treatment and surgical decision-making. LEVEL OF EVIDENCE: II - Systematic Review.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.