Diagnostic or "special" tests performed in our physical examination often do not identify or isolate pathology in the tissues that they were designed to test. The empty beer can and single leg hyperextension tests for example, do not isolate or accurately identify pathology. Do they serve any purpose, and should we even be performing diagnostic tests?
Find out in this 5 Minute Physio tip with David Pope
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Hi I’m David Pope From Clinical Edge, welcome to this weeks 5 minute physio tip on diagnostic tests, are they actually useful? There has been lots of research lately about whether diagnostic tests actually identify the specific structures that they’re supposed to test and whether they do that accurately. So for instance, does the empty beer-can test identify supraspinatus pathology or tendinopathy, and that’s how it’s always been taught as a test for supraspinatus?
No its doesn’t actually pick up if whether there is a supraspinatus tear, tendinopathy or other problems to the supraspinatus. So what’s the usefulness of the test? Is there any point in performing a empty beer-can test if it doesn’t pick up those specific structures? Another example that’s commonly tested is the single leg hyper-extension test, commonly thought of as identifying lumbar stress fractures or spondylolisthesis. So does it do that? No. It doesn’t accurately pick up spondylolisthesis or stress fracture, so is there any use in performing the test?
Now I’m going to talk you through a couple of use case scenarios where all these special tests are actually useful. So for instance we want to know with your patients am I making progress with the treatments performed within that session or with the exercises they’ve been performing between your treatment sessions. So you could use the empty beer-can test as your assessment/re-assessment finding. So when you’re in that position you get 4/10 pain with resisted abduction. So now you’ve got a clear guidance on pain levels while performing that test, then you perform some treatment or exercise then retest it and then you now have pain levels of 2/10. We’re starting to get a clear indication that the patient is heading in the right direction, that we’re having a positive treatment outcome; whereas if you’re getting them back at a 4/10, you don’t know anything more about the supraspinatus pathology, but you do know that you’re not having the desired treatment outcome, and you need to change tack. So that’s one really good example of how you can use your special tests as more of an assessment reassessment finding than identifying specific pathology.
The other way that you can use your specific tests, in this case your one leg hyper-extension test, is as a return to play or screening test. Or as an indicator for when your patients can get back to their sporting activities. So lets take for instance a cricketer that has pain when they’re bowling. And you’ve taken their bowling out because it’s too painful. They’ve got pain during a one leg hyperextension test. Do they have a spondolisthesis? Or stress fracture? Well as we found out we don’t know that from these tests. But we can use that as an indicator to say alright when you can achieve thirty single leg hyperextension tests pain-free, you can start bowling again. So now we’re using that as an indicator, and then the patient goes “Okay I can’t, I can only achieve fifteen” They’re really clear on when they can go back to bowling, they’re going: “Oh okay I can achieve fifteen without pain and I need to achieve thirty. So I’ve got to do more of these exercises you gave me so that I can build up and get to that point of thirty.” So you’re giving your patients a clear indication, and you’ve got a clear indication. And then you can know when you can re-introduce activities like bowling. Once again you’re going to incorporate, like you always do, your load management principles of going righto we actually need to build up and not go nuts with bowling twenty overs. But you’re going to build up your bowling once you’ve achieved this target, this key indicator.
So there are some ideas on how you can use these diagnostic tests as important indicators, assessment, re-assessment findings in your treatments knowing if you’re heading down the right track or not, and they are actually useful. I hope you enjoyed this weeks five-minute physio tip and have a great week!