human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To evaluate a new clinical test , the resisted supination external rotation test , for the diagnosis of superior labral anterior posterior lesions of the shoulder . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods Forty athletes ( average age , 23.9 years ) with activity-related shoulder pain were enrolled in the study . The patients underwent 3 different tests design ed specifically to detect superior labral anterior posterior lesions ( the resisted supination external rotation test , the crank test , and the active compression test ) ; the tests were performed in a r and om order on the affected shoulder . The results of the tests were compared with arthroscopic findings . Results Out of 40 athletes , 29 ( 72.5 % ) had superior labral anterior posterior tears . The resisted supination external rotation test had the highest sensitivity ( 82.8 % ) , specificity ( 81.8 % ) , positive predictive value ( 92.3 % ) , negative predictive value ( 64.3 % ) , and diagnostic accuracy ( 82.5 % ) of all tests performed . Conclusion By re-creating the peel-back mechanism , the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests design ed to diagnose superior labral anterior posterior tears in overhead-throwing athletes . By using this test in the context of a thorough clinical history and physical examination , lesions of the superior labrum can be more reliably diagnosed BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies We describe the biceps load test for evaluating the integrity of the superior glenoid labrum in shoulders with recurrent anterior dislocations . With the shoulder in an abducted , externally rotated position and the forearm supinated , active flexion of the elbow against resistance relieves the discomfort of a st and ard apprehension test for anterior shoulder instability . A group of 75 patients with proven unilateral anterior shoulder dislocations were prospect ively examined in a double-blind fashion with arthroscopic examination and the biceps load test . Sixty-three patients had a negative test and 62 of these had an intact biceps tendon-superior labrum complex ; the remaining patient had a type II superior labral anterior and posterior lesion . Twelve patients had positive tests , and 10 had superior labral lesions ; the other 2 patients had intact superior labra . Therefore , the biceps load test revealed a sensitivity of 90.9 % , a specificity of 96.9 % , a positive predictive value of 83 % , a negative predictive value of 98 % , and a kappa coefficient of 0.846 Background Tears of the superior labrum of the shoulder , anterior to posterior , are difficult to diagnose clinical ly . Purpose We examined whether the crank or O'Brien tests were reliable tools for detecting glenoid labral tears . Study Design Nonr and omized prospect i ve study . Methods Results of diagnostic shoulder arthroscopy were compared with those of the preoperative tests and magnetic resonance imaging for 65 patients who had symptoms of shoulder pain . Results The  crank test result was positive in 29 patients ( 45 % ) , and the O'Brien test was positive in 41 patients ( 63 % ) . The crank  test had a positive predictive value of 41 % , was 56 % specific , 46 % sensitive , and had a negative predictive value of 61 % . The  O'Brien test  had a positive predictive value of 34 % , was 31 % specific , 54 % sensitive , and had a negative predictive value of 50 % . Magnetic resonance imaging had a positive predictive value of 63 % , was 92 % specific , 42 % sensitive , and had a negative predictive value of 83 % . Conclusions The O'Brien and crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum . Results were often falsely positive for patients with other shoulder conditions , including impingement or rotator cuff tears Labral tears and acromioclavicular joint abnormalities were differentiated on physical examination using a new diagnostic test . The st and ing patient forward flexed the arm to 90 ° with the elbow in full extension and then adducted the arm 10 ° to 15 ° medial to the sagittal plane of the body and internally rotated it so that the thumb pointed downward . The examiner , st and ing behind the patient , applied a uniform downward force to the arm . With the arm in the same position , the palm was then fully supinated and the maneuver was repeated . The test was considered positive if pain was elicited during the first maneuver , and was reduced or eliminated with the second . Pain localized to the acromioclavicular joint or “ on top ” was diagnostic of acromioclavicular joint abnormality , whereas pain or painful clicking described as “ inside ” the shoulder was considered indicative of labral abnormality . A prospect i ve study was performed on 318 patients to determine the sensitivity , specificity , and positive and negative predictive values of the test . Fifty-three of 56 patients whose preoperative examinations indicated a labral tear had confirmed labral tears that were repaired at surgery . Fifty-five of 62 patients who had pain in the acromioclavicular joint and whose preoperative examinations indicated abnormalilties in the joint had positive clinical , operative , or radiographic evidence of acromioclavicular injury . There were no false-negative results in either group Background Although there are many studies describing tests for shoulder instability , there are few assessing the validity of these tests in diagnosing anterior shoulder instability . Purpose To assess the validity of the apprehension , relocation , and surprise tests as predictors of anterior shoulder instability . Study Design Retrospective review of prospect ively collected data . Methods Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent , blinded examiners : traumatic anterior instability ( 18 ) , rotator cuff tendinosis ( 17 ) , posterior instability ( 2 ) , glenohumeral osteoarthritis ( 4 ) , or multidirectional instability ( 5 ) .  Interobserver reliability was also determined . Results In subjects who had a feeling of apprehension on all three tests , the mean positive and negative predictive values were 93.6 % and 71.9 % , respectively . The surprise test was the single most accurate test ( sensitivity = 63.89 % ; specificity = 98.91 % ) . An improvement in the feeling of apprehension or painwith the relocation test added little to the value of the tests . Interobserver reliability was determined to be 0.83 . Conclusions and Clinical Relevance The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability PURPOSE The purpose of this report is to describe the biceps load test II for evaluating the  superior labral anterior and posterior ( SLAP ) lesions .  TYPE OF STUDY This is a double-blind study in consecutive data , which includes diagnostic accuracy of a test using sensitivity , specificity , and interexaminer reliability . METHODS In the supine position , the arm is elevated to 120 degrees and externally rotated to its maximal point , with the elbow in the 90 degrees flexion and the forearm in the supinated position . The patient is asked to flex the elbow while resisting the elbow flexion by the examiner . The test is considered positive if the patient complains of pain during the resisted elbow flexion . The test is negative if pain is not elicited or if the pre-existing pain during the elevation and external rotation of the arm is unchanged or diminished by the resisted elbow flexion . A prospect i ve study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test II . Two independent examiners were assigned to perform the new diagnostic test . The results of the tests were confirmed during the arthroscopic examination . RESULTS A positive test result in 38 subjects correlated with a SLAP lesion in 35 patients and an intact biceps-superior labrum in 3 patients . A negative test result in 89 patients correlated with an intact superior labrum complex in 85 patients , whereas 4 patients with a negative test result had a type II SLAP lesion . The biceps load test II had a sensitivity of 89.7 % , a specificity of 96.9 % , a positive-predictive value of 92.1 % , a negative-predictive value of 95.5 % , and a kappa coefficient of 0.815 . The abduction and external rotation of the shoulder during the test changes the relative direction of the biceps fiber in a position of oblique angle to the posterosuperior labrum . The resisted contraction of the biceps increases the pain generated on the superior labrum that is already peeled off the glenoid margin in the abducted and externally rotated position . CONCLUSIONS The biceps load test II is an effective diagnostic test for SLAP lesions BACKGROUND Although traumatic anterior shoulder instability is common , the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently . We hypothesized that ( 1 ) such tests would be specific but not sensitive for this condition , ( 2 ) the usefulness of the anterior drawer test would be limited because of pain during the test , and ( 3 ) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms . METHODS Between 2000 and 2004 , 363 patients underwent a physical examination followed by shoulder arthroscopy . Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group , and the remaining patients served as controls . The clinical usefulness of three tests ( anterior apprehension , relocation , and anterior drawer tests ) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity , specificity , and likelihood ratios . RESULTS If demonstration ( or relief ) of apprehension was used as the diagnostic criterion for a positive test , the sensitivity , specificity , and likelihood ratio were 72 % , 96 % , and 20.2 , respectively , for the apprehension test and 81 % , 92 % , and 10.4 , respectively , for the relocation test . If pain ( or relief of pain ) was used as the diagnostic criterion for a positive test , the values for the sensitivity , specificity , and likelihood ratio of both tests were lower . The anterior drawer test could be performed successfully in the physician 's office for 87 % of the patients . If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test , the sensitivity , specificity , and likelihood ratio values of that test were 53 % , 85 % , and 3.6 , respectively . CONCLUSIONS The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive . Apprehension is a better criterion than pain for a positive apprehension or relocation test . The anterior drawer test ( when pain does not prevent it from being performed ) is helpful for diagnosing traumatic anterior instability . LEVEL OF EVIDENCE Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence We conducted this study to determine whether a test , the posterior impingement maneuver , could be used to prospect ively identify articular side tears of the rotator cuff and /or posterior labrum . Sixty-nine athletes presented with posterior shoulder pain that developed during overh and athletics . Injured shoulders were placed into 90 degrees to 110 degrees of abduction , slight extension , and maximum external rotation , and an effort was made to elicit pain deep within the posterior aspect . Overall sensitivity of the test was 75.5 % , and specificity was 85 % . When only athletes with noncontact injuries ( gradual onset of pain ) were considered , 
    Output:
    
agent
No tests for impingement or acromioclavicular ( AC ) joint pathology demonstrated significant diagnostic accuracy .
Based on pooled data , the diagnostic accuracy of the Neer test for impingement , the Hawkins-Kennedy test for impingement and the Speed test for labral pathology is limited .
Currently , almost without exception , there is a lack of clarity with regard to whether common OSTs used in clinical examination are useful in differentially diagnosing pathologies of the shoulder
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose To evaluate a new clinical test , the resisted supination external rotation test , for the diagnosis of superior labral anterior posterior lesions of the shoulder . Study Design Cohort study ( diagnosis ) ; Level of evidence , 2 . Methods Forty athletes ( average age , 23.9 years ) with activity-related shoulder pain were enrolled in the study . The patients underwent 3 different tests design ed specifically to detect superior labral anterior posterior lesions ( the resisted supination external rotation test , the crank test , and the active compression test ) ; the tests were performed in a r and om order on the affected shoulder . The results of the tests were compared with arthroscopic findings . Results Out of 40 athletes , 29 ( 72.5 % ) had superior labral anterior posterior tears . The resisted supination external rotation test had the highest sensitivity ( 82.8 % ) , specificity ( 81.8 % ) , positive predictive value ( 92.3 % ) , negative predictive value ( 64.3 % ) , and diagnostic accuracy ( 82.5 % ) of all tests performed . Conclusion By re-creating the peel-back mechanism , the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests design ed to diagnose superior labral anterior posterior tears in overhead-throwing athletes . By using this test in the context of a thorough clinical history and physical examination , lesions of the superior labrum can be more reliably diagnosed BACKGROUND Chronic refractory spinal pain poses a peculiar diagnostic challenge because of multiple putative pain sources , overlapping clinical features , and nonspecific radiologic findings . Diagnostic injection techniques are employed to isolate the source ( s ) of pain . Facet or zygapophysial joint pain is an example of spinal pain diagnosed by local anesthetic injections of the facet joint or its nerve supply . Diagnostic facet joint injections are expected to meet the cardinal features of a diagnostic test ( i.e. , accuracy , safety and reproducibility ) . Accuracy must be compared with a " gold " or criterion st and ard that can confirm presence or absence of a disease . There is , however , no available gold st and ard , such as biopsy , to measure presence or absence of pain . Hence , there is a degree of uncertainty concerning the accuracy of diagnostic facet joint injections . OBJECTIVES To evaluate accuracy , safety and reproducibility of facet or zygapophysial joint injections in diagnosing chronic spinal pain of facet joint origin . STUDY DESIGN A systematic review of the literature for clinical studies on efficacy and utility of facet joint/nerve injections in diagnosing spinal pain from facet joints . METHODS Relevant literature on diagnostic facet injections was identified through data base search es . Excluded were abstract s , review s , book chapters , case reports and studies based on single blocks or blocks without radiologic control . Prospect i ve studies with placebo control , or controlled comparative local anesthetic blocks , were given priority over retrospective studies . Each study was grade d using AHRQ and QUADAS criteria . The level of evidence was classified as conclusive , strong , moderate , limited , or inconclusive . RESULTS Available literature pointed to strong evidence for controlled comparative local anesthetic facet joint medial branch blocks in the diagnosis of neck and low back pain . There was moderate evidence in the diagnosis of pain arising from thoracic facet joints . CONCLUSION The evidence obtained from literature review suggests that controlled comparative local anesthetic blocks of facet joint nerves ( medial branch or dorsal ramus ) are reproducible , reasonably accurate , and safe . The sensitivity , specificity , false-positive rates , and predictive values of these diagnostic tests for neck and low back pain have been vali date d and reproduced in multiple studies We describe the biceps load test for evaluating the integrity of the superior glenoid labrum in shoulders with recurrent anterior dislocations . With the shoulder in an abducted , externally rotated position and the forearm supinated , active flexion of the elbow against resistance relieves the discomfort of a st and ard apprehension test for anterior shoulder instability . A group of 75 patients with proven unilateral anterior shoulder dislocations were prospect ively examined in a double-blind fashion with arthroscopic examination and the biceps load test . Sixty-three patients had a negative test and 62 of these had an intact biceps tendon-superior labrum complex ; the remaining patient had a type II superior labral anterior and posterior lesion . Twelve patients had positive tests , and 10 had superior labral lesions ; the other 2 patients had intact superior labra . Therefore , the biceps load test revealed a sensitivity of 90.9 % , a specificity of 96.9 % , a positive predictive value of 83 % , a negative predictive value of 98 % , and a kappa coefficient of 0.846 Background Tears of the superior labrum of the shoulder , anterior to posterior , are difficult to diagnose clinical ly . Purpose We examined whether the crank or O'Brien tests were reliable tools for detecting glenoid labral tears . Study Design Nonr and omized prospect i ve study . Methods Results of diagnostic shoulder arthroscopy were compared with those of the preoperative tests and magnetic resonance imaging for 65 patients who had symptoms of shoulder pain . Results The  crank test result was positive in 29 patients ( 45 % ) , and the O'Brien test was positive in 41 patients ( 63 % ) . The crank  test had a positive predictive value of 41 % , was 56 % specific , 46 % sensitive , and had a negative predictive value of 61 % . The  O'Brien test  had a positive predictive value of 34 % , was 31 % specific , 54 % sensitive , and had a negative predictive value of 50 % . Magnetic resonance imaging had a positive predictive value of 63 % , was 92 % specific , 42 % sensitive , and had a negative predictive value of 83 % . Conclusions The O'Brien and crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum . Results were often falsely positive for patients with other shoulder conditions , including impingement or rotator cuff tears Labral tears and acromioclavicular joint abnormalities were differentiated on physical examination using a new diagnostic test . The st and ing patient forward flexed the arm to 90 ° with the elbow in full extension and then adducted the arm 10 ° to 15 ° medial to the sagittal plane of the body and internally rotated it so that the thumb pointed downward . The examiner , st and ing behind the patient , applied a uniform downward force to the arm . With the arm in the same position , the palm was then fully supinated and the maneuver was repeated . The test was considered positive if pain was elicited during the first maneuver , and was reduced or eliminated with the second . Pain localized to the acromioclavicular joint or “ on top ” was diagnostic of acromioclavicular joint abnormality , whereas pain or painful clicking described as “ inside ” the shoulder was considered indicative of labral abnormality . A prospect i ve study was performed on 318 patients to determine the sensitivity , specificity , and positive and negative predictive values of the test . Fifty-three of 56 patients whose preoperative examinations indicated a labral tear had confirmed labral tears that were repaired at surgery . Fifty-five of 62 patients who had pain in the acromioclavicular joint and whose preoperative examinations indicated abnormalilties in the joint had positive clinical , operative , or radiographic evidence of acromioclavicular injury . There were no false-negative results in either group Background Although there are many studies describing tests for shoulder instability , there are few assessing the validity of these tests in diagnosing anterior shoulder instability . Purpose To assess the validity of the apprehension , relocation , and surprise tests as predictors of anterior shoulder instability . Study Design Retrospective review of prospect ively collected data . Methods Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent , blinded examiners : traumatic anterior instability ( 18 ) , rotator cuff tendinosis ( 17 ) , posterior instability ( 2 ) , glenohumeral osteoarthritis ( 4 ) , or multidirectional instability ( 5 ) .  Interobserver reliability was also determined . Results In subjects who had a feeling of apprehension on all three tests , the mean positive and negative predictive values were 93.6 % and 71.9 % , respectively . The surprise test was the single most accurate test ( sensitivity = 63.89 % ; specificity = 98.91 % ) . An improvement in the feeling of apprehension or painwith the relocation test added little to the value of the tests . Interobserver reliability was determined to be 0.83 . Conclusions and Clinical Relevance The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability PURPOSE The purpose of this report is to describe the biceps load test II for evaluating the  superior labral anterior and posterior ( SLAP ) lesions .  TYPE OF STUDY This is a double-blind study in consecutive data , which includes diagnostic accuracy of a test using sensitivity , specificity , and interexaminer reliability . METHODS In the supine position , the arm is elevated to 120 degrees and externally rotated to its maximal point , with the elbow in the 90 degrees flexion and the forearm in the supinated position . The patient is asked to flex the elbow while resisting the elbow flexion by the examiner . The test is considered positive if the patient complains of pain during the resisted elbow flexion . The test is negative if pain is not elicited or if the pre-existing pain during the elevation and external rotation of the arm is unchanged or diminished by the resisted elbow flexion . A prospect i ve study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test II . Two independent examiners were assigned to perform the new diagnostic test . The results of the tests were confirmed during the arthroscopic examination . RESULTS A positive test result in 38 subjects correlated with a SLAP lesion in 35 patients and an intact biceps-superior labrum in 3 patients . A negative test result in 89 patients correlated with an intact superior labrum complex in 85 patients , whereas 4 patients with a negative test result had a type II SLAP lesion . The biceps load test II had a sensitivity of 89.7 % , a specificity of 96.9 % , a positive-predictive value of 92.1 % , a negative-predictive value of 95.5 % , and a kappa coefficient of 0.815 . The abduction and external rotation of the shoulder during the test changes the relative direction of the biceps fiber in a position of oblique angle to the posterosuperior labrum . The resisted contraction of the biceps increases the pain generated on the superior labrum that is already peeled off the glenoid margin in the abducted and externally rotated position . CONCLUSIONS The biceps load test II is an effective diagnostic test for SLAP lesions BACKGROUND Although traumatic anterior shoulder instability is common , the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently . We hypothesized that ( 1 ) such tests would be specific but not sensitive for this condition , ( 2 ) the usefulness of the anterior drawer test would be limited because of pain during the test , and ( 3 ) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms . METHODS Between 2000 and 2004 , 363 patients underwent a physical examination followed by shoulder arthroscopy . Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group , and the remaining patients served as controls . The clinical usefulness of three tests ( anterior apprehension , relocation , and anterior drawer tests ) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity , specificity , and likelihood ratios . RESULTS If demonstration ( or relief ) of apprehension was used as the diagnostic criterion for a positive test , the sensitivity , specificity , and likelihood ratio were 72 % , 96 % , and 20.2 , respectively , for the apprehension test and 81 % , 92 % , and 10.4 , respectively , for the relocation test . If pain ( or relief of pain ) was used as the diagnostic criterion for a positive test , the values for the sensitivity , specificity , and likelihood ratio of both tests were lower . The anterior drawer test could be performed successfully in the physician 's office for 87 % of the patients . If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test , the sensitivity , specificity , and likelihood ratio values of that test were 53 % , 85 % , and 3.6 , respectively . CONCLUSIONS The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive . Apprehension is a better criterion than pain for a positive apprehension or relocation test . The anterior drawer test ( when pain does not prevent it from being performed ) is helpful for diagnosing traumatic anterior instability . LEVEL OF EVIDENCE Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence We conducted this study to determine whether a test , the posterior impingement maneuver , could be used to prospect ively identify articular side tears of the rotator cuff and /or posterior labrum . Sixty-nine athletes presented with posterior shoulder pain that developed during overh and athletics . Injured shoulders were placed into 90 degrees to 110 degrees of abduction , slight extension , and maximum external rotation , and an effort was made to elicit pain deep within the posterior aspect . Overall sensitivity of the test was 75.5 % , and specificity was 85 % . When only athletes with noncontact injuries ( gradual onset of pain ) were considered , 
    Output:
    