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Evidence‐based criteria for palaeopathological recognition: New methodology suggests that the rotator cuff condition will be amenable to reliable identification in the archeologic record
Author(s) -
Rothschild Bruce M.
Publication year - 2019
Publication title -
international journal of osteoarchaeology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 60
eISSN - 1099-1212
pISSN - 1047-482X
DOI - 10.1002/oa.2793
Subject(s) - rotator cuff , medicine , reliability (semiconductor) , shoulders , identification (biology) , physical therapy , physical medicine and rehabilitation , surgery , power (physics) , physics , botany , quantum mechanics , biology
Purpose/research question Pitting or new bone formation on or around tendon insertions, marginal osteophytes, eburnation, cystic changes, and altered contours have been utilized by some palaeopathologists for recognition of the rotator cuff condition, with the purpose of this paper to evaluate the reliability for diagnosis (sensitivity and specificity) of these criteria as documented in the clinical literature. Materials and methods The spectrum of medical literature is examined without time limitation, utilizing the phrase “rotator cuff” to assess criteria utilized for diagnosis of a rotator cuff conditions, the reliability of those criteria, and the relationship to symptoms and limitations/disability. Results None of the skeletal features previously referred to by palaeopathologists have reliable indicators for recognition and may simply be age‐related phenomena. New methodology is described, offering the opportunity for confident diagnosis. Conclusions There have been no validated evidence‐based criteria applicable for recognizing rotator cuff conditions in skeletons, in the absence of soft tissue structures. Greater tuberosity osteopenia has been noted but not yet evaluated for specificity. Rotator cuff conditions may actually be unrelated to lifestyle but may simply represent the accumulation/culmination of lifetime stresses (aging). The ratio of acromial lateral extension and height provides greater opportunity for confident diagnosis. Given the disconnection between presence or extent of pathology and clinical symptoms and limitations/disability, identification of any of the components utilized in previous consideration of rotator cuff disease diagnosis does not permit extrapolation to confidently hypothesize lifestyle or occupation. Contribution to knowledge/originality/value Documents a methodology for confident diagnosis of rotator cuff disease and the challenge of confident attribution of skeletal conditions and clinical/lifestyle implications Limitations of this study Evidence, rather than conjecture/consensus‐based. Suggestions for further research Population survey utilizing ratio of acromial length extension and height.

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