Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
Department of Radiology, University Hospital Limerick, Limerick, Ireland.
Br J Sports Med. 2015 Mar;49(5):298-305. doi: 10.1136/bjsports-2012-092063. Epub 2013 Jul 2.
Narrowing of the subacromial space has been noted as a common feature of rotator cuff (RC) tendinopathy. It has been implicated in the development of symptoms and forms the basis for some surgical and rehabilitation approaches. Various radiological methods have been used to measure the subacromial space, which is represented by a two-dimensional measurement of acromiohumeral distance (AHD). A reliable method of measurement could be used to assess the impact of rehabilitation or surgical interventions for RC tendinopathy; however, there are no published reviews assessing the reliability of AHD measurement.
The aim of this review was to systematically assess the evidence for the intrarater and inter-rater reliability of radiological methods of measuring AHD, in order to identify the most reliable method for use in RC tendinopathy.
An electronic literature search was carried out and studies describing the reliability of any radiological method of measuring AHD in either healthy or RC tendinopathy groups were included. Eighteen studies met the inclusion criteria and were appraised by two reviewers using the Quality Appraisal for reliability Studies checklist.
Eight studies were deemed to be of high methodological quality. Study weaknesses included lack of tester blinding, inadequate description of tester experience, lack of inclusion of symptomatic populations, poor reporting of statistical methods and unclear diagnosis. There was strong evidence for the reliability of ultrasound for measuring AHD, with moderate evidence for MRI and CT measures and conflicting evidence for radiographic methods. Overall, there was lack of research in RC tendinopathy populations, with only six studies including participants with shoulder pain.
The results support the reliability of ultrasound and CT or MRI for the measurement of AHD; however, more studies in symptomatic populations are required. The reliability of AHD measurement using radiographs has not been supported by the studies reviewed.
肩峰下空间变窄已被认为是肩袖（RC）肌腱病的常见特征。它与症状的发展有关，并构成了一些手术和康复方法的基础。已经使用了各种放射学方法来测量肩峰下空间，该空间由肩峰肱距离（AHD）的二维测量来表示。可靠的测量方法可用于评估 RC 肌腱病康复或手术干预的效果；然而，目前尚无评估 AHD 测量可靠性的综述。
本综述的目的是系统评估测量 AHD 的放射学方法的组内和组间可靠性的证据，以确定最可靠的方法用于 RC 肌腱病。
进行了电子文献检索，并纳入了描述任何放射学方法测量健康或 RC 肌腱病组中 AHD 可靠性的研究。有 18 项研究符合纳入标准，由两名评审员使用可靠性研究质量评估清单进行评估。
有 8 项研究被认为具有较高的方法学质量。研究的弱点包括缺乏测试者盲法、测试者经验描述不足、缺乏症状人群的纳入、统计方法报告不佳以及诊断不明确。有强有力的证据表明超声测量 AHD 的可靠性，MRI 和 CT 测量有中等证据，而放射学方法的证据则存在冲突。总体而言，在 RC 肌腱病人群中缺乏研究，只有 6 项研究纳入了有肩部疼痛的参与者。
研究结果支持超声和 CT 或 MRI 测量 AHD 的可靠性；然而，需要更多针对有症状人群的研究。综述中没有研究支持使用 X 光片测量 AHD 的可靠性。
