Traumatic spinal cord injury leads to chronic impairment and disability. Despite the substantial effects of spinal cord injury on health-related quality of life and health care spending, data on trends in incidence, etiology, and medical care of acute traumatic spinal cord injury in the United States have limited availability from contemporary nationwide studies. Prior incidence rates, including from the Spinal Cord Injury Model Systems,¹ have been calculated based on regional estimates from the 1980s.^2-14 The quantification of acute spinal cord injury incidence is essential to understand its contribution to estimates on persons with disability in the United States. Knowing trends in etiology of acute spinal cord injury would also help identify specific population groups at risk and help target preventive measures.

Objective: Patient-reported outcome scales determine response to treatment. The minimal clinically important difference of these scales is a measure of responsiveness: the smallest change in a score associated with a clinically important change to the patient. This study sought to summarize the literature on minimal clinically important difference for the most commonly reported shoulder outcome scales. Design: A literature search of PubMed and EMBASE databases identified 193 citations, 27 of which met the inclusion/exclusion criteria. Results: For rotator cuff tears, a minimal clinically important difference range of 9–26.9 was reported for American Shoulder and Elbow Surgeons, 8 or 10 for Constant, and 282.6–588.7 for the Western Ontario Rotator Cuff Index. For patients who underwent arthroplasty, a minimal clinically important difference range of 6.3–20.9 was reported for American Shoulder and Elbow Surgeons, 5.7–9.4 for Constant, and 14.1–20.6 for the Shoulder Pain and Disability Index. For proximal humeral fractures, a minimal clinically important difference range of 5.4–11.6 was reported for Constant and 8.1–13.0 for Disability of the Arm, Shoulder, and Hand. Conclusions: A wide range of minimal clinically important difference values was reported for each patient population and instrument. In the future, a uniform outcome instrument and minimal clinically important difference will be useful to measure clinically meaningful change across practices and the spectrum of shoulder diagnoses.

Objective The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears. Design From February 2011 to December 2012, 208 participants with shoulder pain were recruited in a cohort study. Results Among tests for supraspinatus tears, Jobe test had a sensitivity of 88% (95% confidence interval [CI], 80%–96%), specificity of 62% (95% CI, 53%–71%), and likelihood ratio of 2.30 (95% CI, 1.79–2.95). The full can test had a sensitivity of 70% (95% CI, 59%–82%) and a specificity of 81% (95% CI, 74%–88%). Among tests for infraspinatus tears, external rotation lag signs at 0 degrees had a specificity of 98% (95% CI, 96%–100%) and a likelihood ratio of 6.06 (95% CI, 1.30–28.33), and the Hornblower sign had a specificity of 96% (95% CI, 93%–100%) and likelihood ratio of 4.81 (95% CI, 1.60–14.49). Conclusions Jobe test and full can test had high sensitivity and specificity for supraspinatus tears, and Hornblower sign performed well for infraspinatus tears. In general, special tests described for subscapularis tears have high specificity but low sensitivity. These data can be used in clinical practice to diagnose rotator cuff tears and may reduce the reliance on expensive imaging.