Miller Caroline A, Forrester Gail A, Lewis Jeremy S
Physiotherapy Department, University Hospital Birmingham Foundation Trust, Birmingham, United Kingdom.
Arch Phys Med Rehabil. 2008 Jun;89(6):1162-8. doi: 10.1016/j.apmr.2007.10.046.
To investigate whether the lag signs were valid tools in diagnosing full-thickness tears of the rotator cuff.
A same-subject, correlation, double-blinded design was used. The results of the external rotation lag sign, drop sign, and internal rotation lag sign were compared with the criterion standard of diagnostic ultrasound to establish their accuracy.
A regional orthopedic hospital.
Consecutive subjects (N=37), 21 women and 16 men, with shoulder pain referred to a consultant orthopedic surgeon specializing in shoulder conditions were recruited for this investigation.
Not applicable.
Sensitivity, specificity, and positive and negative likelihood ratios of the lag signs when using ultrasound as the reference test.
The specificities of the drop sign and internal rotation lag sign were 77% and 84%, respectively, which, together with low positive likelihood ratios 3.2 (95% confidence interval [CI], 1.5-6.7) and 6.2 (95% CI, 1.9-12.0), indicate that a positive result was poor at recognizing the presence of full-thickness tears. The drop sign had a sensitivity of 73% with a negative likelihood ratio of .34 (95% CI, 0.2-0.8), suggesting that a negative test was fair at ruling out the presence of full-thickness tears. The sensitivity of the internal rotation lag sign (100%) supported by the negative likelihood ratio of 0 (95% CI, 0.0-2.5) suggests that a negative test will effectively rule out the presence of full-thickness tears of the subscapularis. A positive external rotation lag sign is the clinical test most likely to indicate that full-thickness tears of the supraspinatus and infraspinatus are present (specificity, 94%). However, the external rotation lag sign did demonstrate a low sensitivity score of 46% and negative likelihood ratio of .57 (95% CI, 0.4-0.9), which means that a negative test will not rule out the presence of full-thickness tears.
The findings of this investigation suggest that a clinical diagnosis of a full-thickness tear of the rotator cuff cannot be conclusively reached using one or more of the lag signs.
探讨滞后征是否为诊断肩袖全层撕裂的有效工具。
采用同体、相关性、双盲设计。将外旋滞后征、坠落征和内旋滞后征的结果与诊断性超声的标准进行比较，以确定其准确性。
一家地区性骨科医院。
连续纳入37名受试者，其中女性21名，男性16名，均因肩部疼痛转诊至一位专门诊治肩部疾病的骨科顾问医生处，参与本研究。
不适用。
以超声作为参考检测时，滞后征的敏感性、特异性、阳性似然比和阴性似然比。
坠落征和内旋滞后征的特异性分别为77%和84%，同时阳性似然比低，分别为3.2（95%置信区间[CI]，1.5 - 6.7）和6.2（95% CI，1.9 - 12.0），这表明阳性结果在识别全层撕裂的存在方面效果不佳。坠落征的敏感性为73%，阴性似然比为0.34（95% CI，0.2 - 0.8），提示阴性检测在排除全层撕裂的存在方面效果尚可。内旋滞后征的敏感性（100%）以及阴性似然比为0（95% CI，0.0 - 2.5）表明阴性检测将有效排除肩胛下肌全层撕裂的存在。阳性外旋滞后征是最有可能提示存在冈上肌和冈下肌全层撕裂的临床检查（特异性，94%）。然而，外旋滞后征的敏感性得分较低，为46%，阴性似然比为0.57（95% CI，0.4 - 0.9），这意味着阴性检测不能排除全层撕裂的存在。
本研究结果表明，仅使用一种或多种滞后征不能确凿地做出肩袖全层撕裂的临床诊断。
