Lewis Jeremy S, Valentine Rachel E
Therapy Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
BMC Musculoskelet Disord. 2007 Jul 9;8:64. doi: 10.1186/1471-2474-8-64.
Postural abnormality and muscle imbalance are thought to contribute to pain and a loss of normal function in the upper body. A shortened pectoralis minor muscle is commonly identified as part of this imbalance. Clinical tests have been recommended to test for shortening of this muscle. The aim of this study was to evaluate the intra-rater reliability and diagnostic accuracy of the pectoralis minor length test.
Measurements were made in 45 subjects with and 45 subjects without shoulder symptoms. Measurements were made with the subjects lying in supine. In this position the linear distance from the treatment table to the posterior aspect of the acromion was measured on two occasions (separated by a minimum of 30 minutes and additional data collection on other subjects to reduce bias) by one rater. The reliability of the measurements was analyzed using intraclass correlation coefficients (ICC), 95% confidence intervals (CI) and standard error of measurement (SEM). The diagnostic accuracy of the test was investigated by determining the sensitivity, specificity, positive and negative likelihood ratios of the test against a 'gold standard' reference. The assessor remained 'blinded' to data input and the measurements were staggered to reduce examiner bias.
The pectoralis minor length test was found to have excellent intra-rater reliability for dominant and non-dominant side of the subjects without symptoms, and for the painfree and painful side of the subjects with symptoms. The values calculated for the sensitivity, specificity, positive and negative likelihood ratios suggest this test performed in the manner investigated in this study and recommended in the literature, lacks diagnostic accuracy.
The findings of this study suggest that although the pectoralis minor length test demonstrates acceptable clinical reliability, its lack of specificity suggests that clinicians using this test to inform the clinical reasoning process with regard treatment planning must do so with caution.
National Research Register: N0060148286.
姿势异常和肌肉失衡被认为会导致上半身疼痛和正常功能丧失。胸小肌缩短通常被认为是这种失衡的一部分。临床测试被推荐用于检测该肌肉的缩短情况。本研究的目的是评估胸小肌长度测试的评估者内信度和诊断准确性。
对45名有肩部症状的受试者和45名无肩部症状的受试者进行测量。受试者仰卧位进行测量。在此位置，由一名评估者两次测量从治疗台到肩峰后缘的直线距离（两次测量间隔至少30分钟，并对其他受试者进行额外数据收集以减少偏差）。使用组内相关系数（ICC）、95%置信区间（CI）和测量标准误差（SEM）分析测量的可靠性。通过确定该测试相对于“金标准”参考的敏感性、特异性、阳性和阴性似然比来研究该测试的诊断准确性。评估者对数据输入保持“盲态”，测量交错进行以减少检查者偏差。
发现胸小肌长度测试对于无症状受试者的优势侧和非优势侧，以及有症状受试者的无痛侧和疼痛侧具有出色的评估者内信度。计算出的敏感性、特异性、阳性和阴性似然比的值表明，本研究中所研究并在文献中推荐的该测试方式缺乏诊断准确性。
本研究结果表明，尽管胸小肌长度测试显示出可接受的临床信度，但其缺乏特异性表明，临床医生在使用该测试为治疗计划的临床推理过程提供信息时必须谨慎。
国家研究注册：N0060148286
