Pandya Nirav K, Colton Anne, Webner David, Sennett Brian, Huffman G Russell
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Arthroscopy. 2008 Mar;24(3):311-7. doi: 10.1016/j.arthro.2007.09.004. Epub 2007 Nov 9.
The overall purpose of our study was to examine the sensitivity of physical examination, magnetic resonance imaging (MRI), and magnetic resonance (MR) arthrogram for the identification of arthroscopically confirmed SLAP lesions of the shoulder.
An analysis of 51 consecutive patients with arthroscopically confirmed SLAP lesions and no history of shoulder dislocation was performed. Before undergoing surgery, all patients underwent a standardized physical examination and had either an MRI and/or MR arthrogram performed. Sensitivity analysis was then performed on the results of both the physical examination maneuvers and the radiologic imaging compared to the arthroscopic findings at surgery.
The sensitivity of O'Brien's (active compression) test was 90%, whereas the Mayo (dynamic) shear was 80% and Jobe's relocation test was 76%. The sensitivity of a physical examination with any 1 of these 3 SLAP provocative tests being positive was 100%. Neer's sign (41%) and Hawkin's impingement tests (31%) each had low sensitivity for SLAP lesions. The sensitivity of MRI for SLAP lesions was 67% when interpreted by the performing surgeon, 53% when read by a radiologist. When the MR arthrograms were analyzed alone, the sensitivity was 72% (surgeon) and 50% (radiologist), respectively.
All 3 physical examination maneuvers traditionally considered provocative for SLAP pathology (O'Brien's, Mayo shear, and Jobe's relocation) were sensitive for the diagnosis of SLAP lesions. MRI and MR arthrogram imaging had lower sensitivity than these physical examination tests in diagnosing SLAP lesions. Patient history, demographics, and the surgeon's physical examination should remain central to the diagnosis of SLAP lesions.
Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
我们研究的总体目的是检验体格检查、磁共振成像（MRI）和磁共振（MR）关节造影对经关节镜证实的肩部SLAP损伤的识别敏感性。
对51例经关节镜证实为SLAP损伤且无肩关节脱位病史的连续患者进行分析。在手术前，所有患者均接受标准化体格检查，并进行了MRI和/或MR关节造影。然后将体格检查操作结果和放射学成像结果与手术时的关节镜检查结果进行敏感性分析。
奥布赖恩（主动加压）试验的敏感性为90%，而梅奥（动态）剪切试验为80%，乔布复位试验为76%。这三种SLAP激发试验中任何一种呈阳性的体格检查敏感性为100%。尼尔征（41%）和霍金斯撞击试验（31%）对SLAP损伤的敏感性均较低。由主刀医生解读时，MRI对SLAP损伤的敏感性为67%，由放射科医生解读时为53%。单独分析MR关节造影时，敏感性分别为72%（主刀医生）和50%（放射科医生）。
传统上认为对SLAP病理有激发作用的所有三种体格检查操作（奥布赖恩试验、梅奥剪切试验和乔布复位试验）对SLAP损伤的诊断均敏感。在诊断SLAP损伤方面，MRI和MR关节造影成像的敏感性低于这些体格检查试验。患者病史、人口统计学特征和医生的体格检查仍应是SLAP损伤诊断的核心。
二级，基于连续患者采用通用金标准制定诊断标准。
