Thirty-two additional studies were included in this updated review. Study sizes were not presented. About half of the studies had high or unclear risk of bias for patient flow and reference standard criteria. Twelve studies adopted the suboptimal reference standard of diagnostic ultrasound (not the criterion standard for shoulder diagnosis).
For subacromial impingement, none of Hawkins-Kennedy, Neer or painful arc tests show high discriminative diagnostic ability. The Hawkins-Kennedy test had the highest DOR (5.18, 95% CI 3.64 to 7.35; seven studies). The DOR was generally higher when the gold standard of surgery was used for index test confirmation.
For superior labral anterior to posterior tears all eight diagnostic tests had likelihood ratios and DORs that were weak and their confidence intervals contained the null value of no discriminative ability. Active compression was used in the largest number of studies (six studies; DOR 1.19, 95% CI 0.76 to 1.86)
For anterior instability the surprise, apprehension and relocation tests all showed good diagnostic ability with high specificity. The apprehension test had the highest DOR (53.6, 95% CI 24.3 to 118.3; two studies) and highest positive likelihood ratio. The surprise test had highest sensitivity (81.8%, 95% CI 69.1 to 90.9; two studies) and the best negative likelihood ratio.
For tendinopathy the Hawkins-Kennedy test did not have good diagnostic performance (DOR 4.68, 95% CI 3.35 to 6.53; three studies). For labral tear the Crank test had limited performance (DOR 5.81, 95% CI 0.47 to 71.5; three studies).
Nine studies assessed the combination of tests but no combination was used in more than one study.
Full results were presented in the paper.