We would like to present this service evaluation of Taylor Spatial Frame use within a busy limb reconstruction unit.

We present a cohort of 60 patients representing a year of work from January 2011 to January 2012 with a breakdown of coding data. Included are details of operative episodes, length of stay, outpatient follow up including software programming episodes, strut changes and general frame care from our specialist nurses. We have produced a comparison of cost to HRG coding tarifs with an audit of coding errors and cost implications of these corrections. Also included is a breakdown of comparison data from patients undergoing frame assisted deformity correction and internal fixation, Computer Hexapod Assisted Orthopaedic Surgery.

Exact and careful coding of these procedures is required considering their relatively high cost.

Introduction: The current accepted clinical tests to confirm rotator cuff tears include a triad of weakness in resisted external rotation, pain on impingement, and weakness on supraspinatus testing (Empty can test). A combination of two of the above in a patient over 60 years also suggests a cuff tear. We present a new simple clinical test, to diagnose rotator cuff tears. ‘Lateral Jobe test’: The lateral Jobe test consists of the patient holding their arms in 90 degrees abduction in the coronal plane with the elbows flexed 90 degrees and the hands pointing inferiorly with the thumbs directed medially. A positive test consists of pain or weakness on resisting downward pressure on the arms or an inability to perform the test.

Methods: Between Sep 2006 and Jan 2007, a consecutive series of 175 patients with painful shoulders who were about to undergo arthroscopic treatment of their shoulders were reviewed prospectively. Their average age was 53 years. There were 97 males and 78 females. Those with fracture or previous surgery were excluded. They were examined preoperatively by two independent orthopaedic surgeons for four tests, the lateral Jobe and the triad of combination examinations mentioned above. They were blinded to the provisional diagnosis. The results of the all the clinical tests were validated against arthroscopic findings.

Results: Of the 175 patients, 102 patients had rotator cuff tear confirmed arthroscopically. 91 patients had positive ‘Lateral Jobe test’ of which 83 had rotator cuff tear (positive predictive value 91%). When compared against the combination of three clinical signs namely impingment sign, weak resisted external rotation and positive empty can test, the Lateral Jobe test had a higher sensitivity (81 vs. 58%) and negative predictive value (77 vs. 60%). The specificity of both was similar at 89 and 88% respectively.

Conclusion: The lateral Jobe test is a simple single test to diagnose rotator cuff tears.