三种常见的创伤性前肩关节不稳检查方法的临床评估

Clinical assessment of three common tests for traumatic anterior shoulder instability.

作者信息

Farber Adam J, Castillo Renan, Clough Mark, Bahk Michael, McFarland Edward G

机构信息

Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21224, USA.

出版信息

J Bone Joint Surg Am. 2006 Jul;88(7):1467-74. doi: 10.2106/JBJS.E.00594.

DOI:10.2106/JBJS.E.00594

PMID:16818971

Abstract

BACKGROUND

Although traumatic anterior shoulder instability is common, the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently. We hypothesized that (1) such tests would be specific but not sensitive for this condition, (2) the usefulness of the anterior drawer test would be limited because of pain during the test, and (3) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms.

METHODS

Between 2000 and 2004, 363 patients underwent a physical examination followed by shoulder arthroscopy. Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group, and the remaining patients served as controls. The clinical usefulness of three tests (anterior apprehension, relocation, and anterior drawer tests) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity, specificity, and likelihood ratios.

RESULTS

If demonstration (or relief) of apprehension was used as the diagnostic criterion for a positive test, the sensitivity, specificity, and likelihood ratio were 72%, 96%, and 20.2, respectively, for the apprehension test and 81%, 92%, and 10.4, respectively, for the relocation test. If pain (or relief of pain) was used as the diagnostic criterion for a positive test, the values for the sensitivity, specificity, and likelihood ratio of both tests were lower. The anterior drawer test could be performed successfully in the physician's office for 87% of the patients. If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test, the sensitivity, specificity, and likelihood ratio values of that test were 53%, 85%, and 3.6, respectively.

CONCLUSIONS

The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive. Apprehension is a better criterion than pain for a positive apprehension or relocation test. The anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability.

LEVEL OF EVIDENCE

Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.

摘要

背景

尽管创伤性前肩关节不稳很常见，但很少有研究探讨各种体格检查测试作为诊断该疾病工具的实用性。我们假设：（1）这些测试对此疾病具有特异性，但不具有敏感性；（2）由于测试过程中疼痛，前抽屉试验的实用性有限；（3）如果前抽屉试验能再现不稳症状，那么它将有助于诊断。

方法

2000年至2004年间，363例患者接受了体格检查，随后进行了肩关节镜检查。我们的研究组纳入了46例经关节镜检查发现或创伤后影像学记录证实为创伤性前肩关节不稳的患者，其余患者作为对照。然后采用统计学方法评估体格检查中用于诊断创伤性前不稳的三项测试（前恐惧试验、复位试验和前抽屉试验）的临床实用性，以评估其敏感性、特异性和似然比。

结果

如果将恐惧的表现（或缓解）作为测试阳性的诊断标准，恐惧试验的敏感性、特异性和似然比分别为72%、96%和20.2，复位试验分别为81%、92%和10.4。如果将疼痛（或疼痛缓解）作为测试阳性的诊断标准，两项测试的敏感性、特异性和似然比的值均较低。87%的患者可在医生办公室成功进行前抽屉试验。如果将不稳症状的再现作为前抽屉试验阳性的标准，该试验的敏感性、特异性和似然比分别为53%、85%和3.6。