Kryger Ann Isabel, Lassen Christina Funch, Andersen Johan Hviid
Department of Occupational and Environmental Medicine, Copenhagen University Hospital, Bispebjerg, Denmark.
Occup Environ Med. 2007 Nov;64(11):776-81. doi: 10.1136/oem.2005.026260. Epub 2007 May 23.
To present data on pain and physical findings from the elbow region, and to discuss the role of diagnostic criteria in epidemiological studies of epicondylitis.
From a cohort of computer workers a subgroup of 1369 participants, who reported at least moderate pain in the neck and upper extremities, were invited to a standardised physical examination. Two independent physical examinations were performed-one blinded and one not blinded to the medical history. Information concerning musculoskeletal symptoms was obtained by a baseline questionnaire and a similar questionnaire completed on the day of examination.
349 participants met the authors' criteria for being an arm case and 249 were elbow cases. Among the 1369 participants the prevalence of at least mild palpation tenderness and indirect tenderness at the lateral epicondyle was 5.8%. The occurrence of physical findings increased markedly by level of pain score. Only about one half with physical findings fulfilled the authors' pain criteria for having lateral epicondylitis. A large part with physical findings reported no pain at all in the elbow in any of the two questionnaires, 28% and 22%, respectively. Inter-examiner reliability between blinded and not blinded examination was found to be low (kappa value (0.34-0.40)).
Very few with at least moderate pain in the elbow region met common specific criteria for lateral epicondylitis. The occurrence of physical findings increased markedly by level of pain score and the associations were strongest with pain intensity scores given just before the examination. Physical signs were commonly found in subjects with no pain complaints. No further impact was achieved if the physical examination was not blinded to the medical history. Furthermore, the authors propose that pain, clinical signs and disability are studied as separate outcomes, and that the diagnoses of lateral epicondylitis should be used only for cases with classical signs of inflammation reflected by severe pain, which for example conveys some disability.
呈现肘部区域疼痛及体格检查结果的数据，并探讨诊断标准在肱骨外上髁炎流行病学研究中的作用。
从一组计算机工作者中选取1369名报告颈部和上肢至少有中度疼痛的参与者，邀请他们参加标准化体格检查。进行了两次独立的体格检查，一次对病史不知情，一次对病史知情。通过基线问卷和检查当天完成的类似问卷获取有关肌肉骨骼症状的信息。
349名参与者符合作者关于手臂病例的标准，249名是肘部病例。在1369名参与者中，外侧上髁至少有轻度触压痛和间接压痛的患病率为5.8%。体格检查结果的发生率随疼痛评分水平显著增加。只有约一半有体格检查结果的人符合作者关于外侧肱骨外上髁炎的疼痛标准。在两次问卷中，分别有28%和22%有体格检查结果的人报告肘部根本没有疼痛。发现不知情和知情检查之间的检查者间可靠性较低（kappa值为0.34 - 0.40）。
肘部区域至少有中度疼痛的人中很少有人符合外侧肱骨外上髁炎的常见特定标准。体格检查结果的发生率随疼痛评分水平显著增加，且与检查前即刻给出的疼痛强度评分关联最强。体格体征常见于无疼痛主诉的受试者中。如果体格检查对病史知情，则不会有进一步影响。此外，作者建议将疼痛、临床体征和残疾作为单独的结果进行研究，并且外侧肱骨外上髁炎的诊断仅应用于具有由严重疼痛反映的典型炎症体征的病例，例如伴有一定程度的残疾。
