Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA02115, USA.
PM R. 2013 Jan;5(1):45-56. doi: 10.1016/j.pmrj.2012.08.019.
Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability and account for 4.5 million physician visits in the United States annually. A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders. We are not aware of a clinical review article that presents a structured physical examination protocol of the rotator cuff for the interested clinician. To fill this void, we present a physical examination protocol developed on the basis of review of prior literature and our clinical experience from dedicated shoulder practices. Our protocol includes range of motion testing by using a goniometer, strength testing by using a dynamometer, and select special tests. Among the many tests for rotator cuff disorders that have been described, we chose ones that have been more thoroughly assessed for sensitivity and specificity. This protocol can be used to isolate the specific rotator cuff tendon involved. The protocol can typically be completed in 15 minutes. We also discuss the clinical implications and limitations of the physical examination maneuvers described in our protocol. This protocol is thorough yet time efficient for a busy clinical practice. It is useful in the diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology.
肩袖撕裂是导致肩部疼痛和与肩部相关残疾的主要原因，每年有 450 万美国医生就诊。仔细的病史和结构化的体格检查通常足以诊断肩袖疾病。我们不知道有哪篇临床综述文章为有兴趣的临床医生介绍了一种针对肩袖的结构化体格检查方案。为了填补这一空白，我们根据对既往文献的回顾和我们在专门的肩部实践中的临床经验，制定了一种体格检查方案。我们的方案包括使用量角器进行的运动范围测试、使用测力计进行的力量测试以及选择的特殊测试。在描述的许多肩袖疾病的测试中，我们选择了那些经过更彻底评估敏感性和特异性的测试。该方案可用于确定特定的肩袖肌腱受累情况。该方案通常可以在 15 分钟内完成。我们还讨论了我们方案中描述的体格检查操作的临床意义和局限性。该方案全面而又高效，适用于繁忙的临床实践。它可用于诊断肩袖撕裂、撞击综合征和二头肌病变。
