Chen Cheng-wei, Pan Zhe-er, Zhang Chao, Liu Cai-long, Chen Lei
Zhongguo Gu Shang. 2016 May;29(5):434-8.
To evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome (SAIS).
A prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome, Hawkins-Kennedy syndrome, painful arc empty can test and external rotation resistance test, also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement.
The ROC analysis indicated a significant area under the curve (AUC) (AUC=0.62 to 0.73, P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance, Tests with a-LR less than 0.5 were Neer,painful are ,external rotation resistance. The regression analysis found the painful arc, empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful are and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71).
The single test of painful arc, empty can and external rotation resistance, as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS, while the single test of Neer, painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc, empty can and ex ternal rotation resistance are the best combination for the diagnosis of SAIS (when 2 or more are positive), while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative)
评估用于诊断肩峰下撞击综合征（SAIS）的5项特殊检查的可靠性和诊断准确性。
进行一项前瞻性盲法队列研究，对105例肩部疼痛患者进行评估。所有患者均接受了5项特殊综合征检查，包括Neer征、Hawkins-Kennedy征、疼痛弧、空罐试验和外旋抗阻试验，同时还接受了关节镜手术检查。Nikolaus标准被视为SAIS的金标准。通过受试者操作特征（ROC）曲线、敏感性、特异性、阳性似然比（+LR）和阴性似然比（-LR）进行数据准确性分析。采用二元Logistic回归分析找出用于确诊或排除SAIS的最佳检查组合。通过Kappa系数和一致性百分比评估评分者间的可靠性。
ROC分析表明，除Hawkins-Kennedy征外，所有检查的曲线下面积（AUC）均有统计学意义（AUC = 0.62至0.73，P < 0.05）。+LR大于或等于2.0的检查为疼痛弧、空罐试验、外旋抗阻试验；-LR小于0.5的检查为Neer征、疼痛弧、外旋抗阻试验。回归分析发现，疼痛弧、空罐试验和外旋抗阻试验是诊断SAIS的最佳组合，而疼痛弧和外旋抗阻试验是排除SAIS的最佳组合。当5项检查中有3项及以上为阳性时，ROC分析差异有统计学意义。所有检查的一致性为中度至良好（Kappa = 0.42至0.71）。
疼痛弧、空罐试验和外旋抗阻试验单项检查，以及5项检查中3项及以上阳性有助于确诊SAIS，而Neer征、疼痛弧和外旋抗阻试验单项检查有助于排除SAIS诊断。疼痛弧、空罐试验和外旋抗阻试验是诊断SAIS的最佳组合（当2项及以上为阳性时），而疼痛弧和外旋抗阻试验是排除SAIS的最佳组合（当两者均为阴性时）
