text: Number of the 62 patients given specific diagnosis by a | Open-i
  Intertester reliability of shoulder complaints diagnoses in primary health care
  Objective: Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting.
  Setting: Four primary health care clinicians used patients' history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints.
  Subjects: 62 patients, aged 18–75 years.
  Main outcome measure: Reliability of diagnoses was assessed by observed intertester agreement and Cohen's kappa. A total of 372 diagnostic pairs were available for intertester comparisons.
  Results: Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73).
  Conclusions: Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints.
  Key points: Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients.
  Key points: • Agreements on diagnoses were generally better than the agreement on individual tests.
  Key points: • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion.
  Key points: • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.
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  Figure 0002: Number of the 62 patients given specific diagnosis by all four, three of four, two of four, or one of four of the clinicians.*Rotator cuff includes supraspinatus-, infraspinatus-, and subscapularis-tendinopathies;**bursitis includes chronic and acute subacromial and subdeltoid bursitis.
  Mentions: Observed agreement on the necessity of a preliminary examination of the cervical spine was high. Due to three missing, 363 pairs were available for analysis, 115 pairs agreed on the necessity of preliminary examination, and 226 agreed on no necessity of this test (22 pairs disagreed), observed agreement 0.94, kappa 0.87 (95% CI 0.81, 0.95). All clinicians agreed on six specific diagnoses in at least one patient: supraspinatus-, infraspinatus-, and subscapularis-tendinopathies, chronic subacromial bursitis, glenohumeral capsulitis, and acromioclavicular joint lesion (Figure 2). At least one clinician diagnosed one-half of the patients with glenohumeral capsulitis, and all four clinicians agreed that 12 of the patients met the diagnostic criteria for this diagnosis (Figure 2). Of the 17 patients given a diagnosis of supraspinatus-tendinopathy, five received this diagnosis from all four clinicians. Observed agreement ranged from 0.84 for glenohumeral capsulitis to 0.97 for the acromioclavicular joint lesion. The corresponding kappa scores were 0.66 (95% CI 0.57, 0.73) for glenohumeral capsulitis, 0.78 (95% CI 0.61, 0.90) for acromioclavicular lesion, 0.53 (95% CI 0.34, 0.68) for infraspinatus-, 0.59 (95% CI 0.47, 0.70) for supraspinatus-, and 0.68 (95% CI 0.53, 0.82) for subscapularis-tendinopathy, respectively (Table 3).