Accident and Emergency Department, Ruttonjee Hospital, Hong Kong, SAR, China.
Am J Emerg Med. 2012 Oct;30(8):1522-9. doi: 10.1016/j.ajem.2011.12.022. Epub 2012 Mar 3.
This study was undertaken to validate the diagnostic values of 9 different physical tests in emergency department patients with primary anterior shoulder dislocation (PASD) to select the best screening test for full-thickness rotator cuff tear (FTRCT) after PASD.
A prospective analysis of 49 consecutive patients with x-ray-confirmed PASD was performed. All patients were followed at an average of 6.9 days (ranged from 4 to 10 days) in the emergency department. On the day of follow-up, 9 physical tests (namely, Jobe test, external rotation lag sign test, infraspinatus muscle strength test, dropping test, drop test, liftoff test, internal rotation lag sign test, belly-press test, and belly-off test) followed by shoulder ultrasound scan were performed to detect FTRCT.
The prevalence of FTRCT after PASD is 37% (95% confidence interval [CI], 24%-52%). Fourteen percent of the patients with PASD were complicated with isolated supraspinatus tendon tear, whereas 22% were complicated with supraspinatus tendon tear combined with subscapularis and/or infraspinatus tendon tear. Jobe test has the highest sensitivity among the 9 physical tests being evaluated. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for positive test, and likelihood ratio for negative test of Jobe test as a screening test for FTRCT after PASD are 89% (95% CI, 64%-98%), 55% (95% CI, 36%-72%), 53% (95% CI, 35%-71%), 89% (95% CI, 65%-98%), 1.97 (95% CI, 1.29-2.99), and 0.20 (95% CI, 0.05-0.79), respectively.
The prevalence of FTRCT after PASD is 37% (95% CI, 24%-52%). Jobe test has the highest sensitivity (89% CI, 64%-98%) among the tests.
本研究旨在验证 9 种不同的物理检查在急诊首发肩关节前脱位（PASD）患者中的诊断价值，以选择 PASD 后全层肩袖撕裂（FTRCT）的最佳筛查试验。
对 49 例经 X 线证实的 PASD 连续患者进行前瞻性分析。所有患者均在急诊科平均随访 6.9 天（4 至 10 天）。在随访日，对 9 项物理检查（即 Jobe 试验、外旋滞后征试验、冈下肌力量试验、落臂试验、落臂试验、抬离试验、内旋滞后征试验、压腹试验和离腹试验）后进行肩部超声扫描，以检测 FTRCT。
PASD 后 FTRCT 的患病率为 37%（95%置信区间[CI]，24%-52%）。14%的 PASD 患者伴有单纯冈上肌腱撕裂，22%的患者伴有冈上肌腱撕裂合并肩胛下肌和/或冈下肌腱撕裂。在评估的 9 项物理检查中，Jobe 试验的敏感性最高。Jobe 试验作为 PASD 后 FTRCT 的筛查试验，其敏感性、特异性、阳性预测值、阴性预测值、阳性试验的似然比和阴性试验的似然比分别为 89%（95%CI，64%-98%）、55%（95%CI，36%-72%）、53%（95%CI，35%-71%）、89%（95%CI，65%-98%）、1.97（95%CI，1.29-2.99）和 0.20（95%CI，0.05-0.79）。
PASD 后 FTRCT 的患病率为 37%（95%CI，24%-52%）。在这些检查中，Jobe 试验的敏感性最高（89%CI，64%-98%）。
