Laursen Lise H, Sjøgaard Gisela, Hagert C G, Jepsen J R
Research Unit of Maritime Medicine, University of Southern Denmark, Esbjerg, Denmark.
Med Lav. 2007 Mar-Apr;98(2):127-44.
Upper limb disorders (ULDs) are common, and so are the difficulties in specific diagnoses of these disorders. Prior studies have shed light on the nerves in the diagnostic approach beside disorders related to muscles, tendons and joints (MCDs).
The study aimed to compare the distribution of upper limb disorders, and the vibration perception threshold (VPT) in different diagnostic groups according to 1) A-criteria: the SALTSA consensus criteria, including MCDs and four peripheral neuropathies, and 2) B-criteria: including MCDs and 10 different neuropathy diagnoses--re-defined in an attempt to refine diagnostic criteria of peripheral neuropathy in respect of different MCDs; and further to discuss the impact of the presented criteria.
161 patients--recruited from 21 general practitioners--were examined by the same examiner according to the two sets of diagnostic criteria. VPT measurements were conducted in all patients.
Three patients did not fulfill the criteria of any ULD diagnosis. A/B criteria were fulfilled for 181/183 upper limbs, respectively, out of which 29.3%/163.3% were neuropathy diagnoses alone, 23.8%/10.9% MCD alone, and 46.9%/25.7% were categorized as neuropathy in combination with MCD diagnoses. The overall agreement on presence of neuropathy was high (75%), but on focal level there was a large discrepancy. According to the A-criteria, patients with symptoms located at wrist and shoulder were primarily defined with wrist diagnoses, and only few had concomitant shoulder diagnoses. In contrast, the B-criteria primarily defined neuropathy located at the shoulder, often concomitantly with neuropathy of the radial and the median nerve at the elbow, but seldom at the wrist level. In MCDs defined by both sets of criteria--Rotator cuff syndrome and medial/lateral epicondylitis--the A-criteria defined more MCDs than the B-criteria, the B diagnoses typically constituted only a part of the A diagnoses and additionally defined neuropathy. The B-criteria showed more significant VPT findings than the A-criteria concerning the discrimination between limbs with and contralateral limbs without diagnoses as well as between diagnostic groups with and without neuropathy.
The VPT findings suggest the B-criteria to be superior to A-criteria for differentiating between patients with and without neuropathy. This study shows that neuropathy is extensive in ULDs when specific diagnostic criteria are used. Additionally it suggests the importance of a critical revision of the current diagnostic criteria of upper limb neuropathy, and the differential diagnoses concerning the MCDs. Management and prevention is highly dependent on correct diagnoses.
上肢疾病（ULD）很常见，对这些疾病进行准确诊断也存在困难。先前的研究已经阐明了在诊断过程中除肌肉、肌腱和关节相关疾病（MCD）之外的神经情况。
本研究旨在根据以下两种标准比较不同诊断组中上肢疾病的分布情况以及振动觉阈值（VPT）：1）A标准：SALTSA共识标准，包括MCD和四种周围神经病变；2）B标准：包括MCD和10种不同的神经病变诊断——重新定义以试图针对不同的MCD细化周围神经病变的诊断标准；并进一步讨论所提出标准的影响。
从21名全科医生处招募的161名患者由同一名检查者根据两套诊断标准进行检查。对所有患者进行VPT测量。
3名患者不符合任何ULD诊断标准。分别有181/183条上肢符合A/B标准，其中单独诊断为神经病变的分别占29.3%/163.3%，单独诊断为MCD的占23.8%/10.9%，同时诊断为神经病变合并MCD的占46.9%/25.7%。在神经病变存在与否方面总体一致性较高（75%），但在局部层面存在较大差异。根据A标准，症状位于腕部和肩部的患者主要被诊断为腕部疾病，只有少数伴有肩部诊断。相比之下，B标准主要诊断位于肩部的神经病变，通常同时伴有肘部桡神经和正中神经病变，但很少涉及腕部层面。在两套标准都定义的MCD——肩袖综合征和内侧/外侧上髁炎中，A标准定义的MCD比B标准多，B标准诊断通常仅构成A标准诊断的一部分，并且还额外定义了神经病变。在区分有诊断和无诊断的肢体以及有神经病变和无神经病变的诊断组方面，B标准比A标准显示出更显著的VPT结果。
VPT结果表明，在区分有无神经病变的患者方面，B标准优于A标准。本研究表明，当使用特定诊断标准时，神经病变在ULD中很常见。此外，这表明对上肢神经病变当前诊断标准以及与MCD相关的鉴别诊断进行严格修订的重要性。管理和预防高度依赖于正确的诊断。
