Silva L, Andréu J L, Muñoz P, Pastrana M, Millán I, Sanz J, Barbadillo C, Fernández-Castro M
Department of Rheumatology, Hospital Universitario Puerta de Hierro, San Martín de Porres 4, Madrid 28035, Spain.
Rheumatology (Oxford). 2008 May;47(5):679-83. doi: 10.1093/rheumatology/ken101. Epub 2008 Mar 27.
Shoulder pain is a common complaint, frequently caused by subacromial impingement syndrome (SIS). There are a number of physical examination (PE) manoeuvres that explore the subacromial space. MRI provides an accurate anatomic image of the subacromial space, being the current gold standard in the diagnosis of SIS. The aim of this study is to evaluate the accuracy of the PE in the diagnosis of SIS and/or subacromial-subdeltoid bursitis (SSB) confirmed by MRI.
Consecutive outpatients with an episode of shoulder pain were prospectively included in the study. They were examined by a rheumatologist and, within 3 days, an MRI was done. Sensitivity, specificity, positive and negative predictive values, and accuracy of PE manoeuvres were calculated using a 2 x 2 table.
Fourteen males and 16 females were included. All the tests exhibited acceptable sensitivity. As a result Yocum manoeuvre was considered the most sensitive and most accurate for SIS. With regard to SSB, the Gerber test was the most sensitive. The majority of the PE manoeuvres showed low specificity.
Most PE manoeuvres identify reasonably well subacromial impingement of the shoulder, although, in general, they have low specificity. The Yocum test has the best sensitivity and precision. Our data suggest that imaging techniques should be recommended to better define shoulder lesions.
肩部疼痛是一种常见症状，常由肩峰下撞击综合征（SIS）引起。有多种体格检查（PE）手法可用于探查肩峰下间隙。MRI能提供肩峰下间隙准确的解剖图像，是目前诊断SIS的金标准。本研究旨在评估体格检查在诊断经MRI确诊的SIS和/或肩峰下-三角肌下滑囊炎（SSB）中的准确性。
连续纳入有肩部疼痛发作的门诊患者进行前瞻性研究。由一名风湿病学家对他们进行检查，并在3天内进行MRI检查。使用2×2列联表计算体格检查手法的敏感性、特异性、阳性和阴性预测值以及准确性。
纳入14名男性和16名女性。所有检查均表现出可接受的敏感性。因此，Yocum手法被认为对SIS最敏感且最准确。对于SSB，Gerber试验最敏感。大多数体格检查手法的特异性较低。
大多数体格检查手法能较好地识别肩部的肩峰下撞击，尽管总体而言它们的特异性较低。Yocum试验具有最佳的敏感性和准确性。我们的数据表明，应推荐使用成像技术以更好地明确肩部病变。
