van der Heijden G J
Institute for Rehabilitation Research, Hoensbroek, and Netherlands School of Primary Care Research, The Netherlands.
Baillieres Best Pract Res Clin Rheumatol. 1999 Jun;13(2):287-309. doi: 10.1053/berh.1999.0021.
This paper provides an up-to-date overview of the occurrence, diagnosis, risk factors, prognostic indicators and outcome of shoulder disorder (SD), and of the validity and reproducibility of diagnostic classifications and diagnostic imaging techniques for SD. Furthermore, the available evidence on the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and physiotherapy for SD is summarized on the basis of randomized controlled trials with an acceptable quality of their methods. The annual incidence of SD is estimated at about 7%, its 1-year period prevalence at about 51% and its lifetime prevalence at about 10%. While approximately 50% of all patients with SD seek medical care, about 95% are treated in primary health care. Of all new episodes of SD presenting to primary care, approximately 50% seem to resolve within 6 months, while about 40% seem to persist for up to 12 months. Several prognostic indicators for a favourable or a poor outcome of SD have been identified, but a comprehensive prognostic model is not available. While evidence for the prognostic validity of popular diagnostic classifications of SD is lacking, their reproducibility has been shown to be poor. The accuracy and clinical usefulness of diagnostic imaging techniques appear to be sufficiently verified for SD in secondary care, while their clinical usefulness in primary care and prognostic validity are not. NSAIDs and steroid injections for SD have been shown to be effective within 6 weeks, but their effect on long-term outcome remains unclear. There is very limited evidence for the effectiveness in SD of physiotherapy, including exercise therapy, ultrasound, electrotherapy, laser, mobilization and manipulation.
本文提供了关于肩部疾病（SD）的发生、诊断、危险因素、预后指标和结局，以及SD诊断分类和诊断成像技术的有效性和可重复性的最新概述。此外，基于方法质量可接受的随机对照试验，总结了非甾体抗炎药（NSAIDs）、皮质类固醇注射和物理治疗对SD有效性的现有证据。SD的年发病率估计约为7%，其1年期间患病率约为51%，终生患病率约为10%。虽然所有SD患者中约50%寻求医疗护理，但约95%在初级卫生保健机构接受治疗。在初级保健机构就诊的所有新发SD病例中，约50%似乎在6个月内缓解，而约40%似乎持续长达12个月。已经确定了几个SD预后良好或不良的预后指标，但尚未有全面的预后模型。虽然缺乏关于SD常用诊断分类预后有效性的证据，但已表明其可重复性较差。诊断成像技术在二级保健中对SD的准确性和临床实用性似乎已得到充分验证，而其在初级保健中的临床实用性和预后有效性尚未得到验证。用于SD的NSAIDs和类固醇注射已显示在6周内有效，但其对长期结局的影响仍不清楚。关于物理治疗（包括运动疗法、超声、电疗法、激光、松动术和手法治疗）对SD有效性的证据非常有限。
