Department of Rheumatology, Università Politecnica delle Marche, Ancona, Italy.
J Clin Rheumatol. 2010 Apr;16(3):105-8. doi: 10.1097/RHU.0b013e3181cf8392.
The aims of the present study were to investigate the clinical value of the provocative clinical tests and propose a composite index for the assessment of painful shoulder, using ultrasonography (US) as reference method.
Two hundred three patients with painful shoulder underwent both clinical and US evaluations. The physical examination was carried out performing the Hawkins, Jobe, Patte, Gerber, and Speed tests. Each test was included in a composite index namely, SNAPSHOT (Simple Numeric Assessment of Pain by SHOulder Tests). The US examination was performed by a rheumatologist experienced in US and blinded to clinical findings. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratio of each clinical test were calculated. The receiver operating characteristic (ROC) curve analysis was used to assess the performance of the composite SNAPSHOT index.
Sensitivity was low for the clinical diagnosis of all shoulder abnormalities. The highest sensitivity and smallest negative likelihood ratio were found for the Hawkins (63.88% and 0.50%) and Patte (62.21% and 0.52%) tests. Specificity was good for Speed (76.33%), Gerber (75.42%), and Patte (74.20%) tests. Patte and Speed tests were the most accurate (71.12% and 66.41%, respectively). The calculated area under the ROC curve related to the SNAPSHOT composite index was 0.881 +/- 0.026. With an optimal cut-off point of 3, the sensitivity and specificity were 75.8% and 87.5%, respectively.
The results of the present study showed that SNAPSHOT is a feasible, informative and quantitative composite index for the assessment of painful shoulder in the clinical setting.
本研究旨在探讨激发试验的临床价值，并提出一种基于超声（US）作为参考方法的肩部疼痛评估综合指数。
203 例肩部疼痛患者均接受了临床和 US 评估。体格检查包括 Hawkins、Jobe、Patte、Gerber 和 Speed 试验。每个试验均包含在一个复合指数中，即 SNAPSHOT（通过肩部试验进行简单数字疼痛评估）。US 检查由一位具有 US 经验且对临床发现盲法的风湿病学家进行。计算每个临床试验的敏感性、特异性、阳性和阴性预测值、阳性和阴性似然比。使用受试者工作特征（ROC）曲线分析评估复合 SNAPSHOT 指数的性能。
所有肩部异常的临床诊断敏感性均较低。Hawkins（63.88%和 0.50%）和 Patte（62.21%和 0.52%）试验的敏感性和最小阴性似然比最高。Speed（76.33%）、Gerber（75.42%）和 Patte（74.20%）试验的特异性较好。Patte 和 Speed 试验最准确（分别为 71.12%和 66.41%）。ROC 曲线下面积与 SNAPSHOT 综合指数相关的计算值为 0.881 +/- 0.026。最佳截断点为 3 时，敏感性和特异性分别为 75.8%和 87.5%。
本研究结果表明，SNAPSHOT 是一种可行、信息丰富且定量的肩部疼痛评估综合指数，适用于临床环境。
