Department of Orthopaedics, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.
Am J Sports Med. 2010 May;38(5):972-5. doi: 10.1177/0363546509357610. Epub 2010 Mar 11.
The treatment options for a first traumatic shoulder dislocation in a young patient are either nonoperative care or primary surgery. It would be valuable to find patient-specific assessments that could predict the risk for redislocation in these patients and thereby identify those who would benefit from primary surgery.
The supine apprehension test, performed after completion of physical therapy in first traumatic shoulder dislocators, can predict risk for redislocation. Patients with a positive test would be at very high risk for redislocation and therefore would be candidates for primary surgery.
Cohort study (prognosis); Level of evidence, 2.
Men aged 17 to 27 years who sustained first traumatic shoulder dislocations were treated in a shoulder immobilizer for 4 weeks and then treated according to a physical therapy protocol. At the 6-week follow-up, an anterior apprehension test was performed to assess risk of redislocation. Follow-up of patients was done at 3 months, 6 months, 1 year, and 2 years. Follow-up continued yearly for up to another 2 years.
Fifty-two men with a mean age of 20.3 years (standard deviation, 2.5) participated. Seventy-nine percent were combat soldiers. Twenty-four participants (46.2%) sustained redislocation. The minimum follow-up period was 24 months (range, 24-48 months; mean, 39.6 months). Redislocations were sustained in 36.8% of participants with negative apprehension tests and 71.4% with positive tests (P = .03). The odds ratio was 4.285 (95% confidence interval, 1.129-16.266). The sensitivity of the apprehension test was 41.7% and the specificity was 85.7%.
The anterior apprehension test performed 6 to 9 weeks after a first traumatic dislocation is not a definitive tool to predict risk for recurrent dislocation. It can, however, categorize patients into groups at higher and lower risk for recurrence. The redislocation rate found in this study is less than that of previous reports.
对于年轻患者首次创伤性肩关节脱位,治疗选择可以是非手术治疗或初次手术。如果能够找到针对特定患者的评估方法,预测这些患者再脱位的风险,从而确定哪些患者将从初次手术中获益,将具有重要的临床价值。
初次创伤性肩关节脱位患者完成物理治疗后进行仰卧位恐惧试验,可预测再脱位风险。阳性试验患者再脱位风险极高,因此是初次手术的候选者。
队列研究(预后);证据等级,2 级。
17~27 岁男性因首次创伤性肩关节脱位接受肩部支具固定治疗 4 周,然后根据物理治疗方案进行治疗。在 6 周随访时,进行前向恐惧试验以评估再脱位风险。对患者进行 3 个月、6 个月、1 年和 2 年的随访。之后每年继续随访,最长可达 2 年。
52 例男性患者的平均年龄为 20.3 岁(标准差为 2.5)。79%为现役军人。24 例(46.2%)患者发生再脱位。最短随访时间为 24 个月(范围为 2448 个月;平均 39.6 个月)。阴性恐惧试验患者中有 36.8%发生再脱位,阳性试验患者中有 71.4%发生再脱位(P =.03)。比值比为 4.285(95%置信区间,1.12916.266)。恐惧试验的敏感度为 41.7%,特异度为 85.7%。
初次创伤性脱位后 6~9 周进行的前向恐惧试验并不是预测复发性脱位风险的可靠工具。然而,它可以将患者分为再脱位风险较高和较低的组。本研究中的再脱位率低于之前的报告。