Ganderton Charlotte, Semciw Adam, Cook Jill, Pizzari Tania
1 Department of Rehabilitation, Nutrition, and Sport, College of Science Health and Engineering, School of Allied Health, La Trobe University , Bundoora, Victoria, Australia .
2 Department of Physiotherapy, The University of Queensland , St Lucia, Queensland, Australia .
J Womens Health (Larchmt). 2017 Jun;26(6):633-643. doi: 10.1089/jwh.2016.5889. Epub 2017 Mar 6.
To evaluate the diagnostic accuracy of 10 clinical tests that can be used in the diagnosis of greater trochanteric pain syndrome (GTPS) in women, and to compare these clinical tests to magnetic resonance imaging (MRI) findings.
Twenty-eight participants with GTPS (49.5 ± 22.0 years) and 18 asymptomatic participants (mean age ± standard deviation [SD], 52.5 ± 22.8 years) were included. A blinded physiotherapist performed 10 pain provocation tests potentially diagnostic for GTPS-palpation of the greater trochanter, resisted external derotation test, modified resisted external derotation test, standard and modified Ober's tests, Patrick's or FABER test, resisted hip abduction, single-leg stance test, and the resisted hip internal rotation test. A sample of 16 symptomatic and 17 asymptomatic women undertook a hip MRI scan. Gluteal tendons were evaluated and categorized as no pathology, mild tendinosis, moderate tendinosis/partial tear, or full-thickness tear.
Clinical test analyses show high specificity, high positive predictive value, low to moderate sensitivity, and negative predictive value for most clinical tests. All symptomatic and 88% of asymptomatic participants had pathological gluteal tendon changes on MRI, from mild tendinosis to full-thickness tear.
The study found the Patrick's or FABER test, palpation of the greater trochanter, resisted hip abduction, and the resisted external derotation test to have the highest diagnostic test accuracy for GTPS. Tendon pathology on MRI is seen in both symptomatic and asymptomatic women.
评估10项可用于诊断女性大转子疼痛综合征（GTPS）的临床检查的诊断准确性，并将这些临床检查结果与磁共振成像（MRI）结果进行比较。
纳入28例GTPS患者（49.5±22.0岁）和18例无症状参与者（平均年龄±标准差[SD]，52.5±22.8岁）。一名不知情的物理治疗师进行了10项可能对GTPS有诊断意义的疼痛激发试验——大转子触诊、抗阻外旋试验、改良抗阻外旋试验、标准和改良奥伯试验、帕特里克试验或FABER试验、抗阻髋关节外展、单腿站立试验以及抗阻髋关节内旋试验。16例有症状和17例无症状女性进行了髋关节MRI扫描。评估臀肌腱并将其分类为无病变、轻度肌腱病、中度肌腱病/部分撕裂或全层撕裂。
临床检查分析显示，大多数临床检查具有高特异性、高阳性预测值、低至中度敏感性和阴性预测值。所有有症状参与者以及88%的无症状参与者在MRI上有臀肌腱病理性改变，从轻度肌腱病到全层撕裂。
研究发现，帕特里克试验或FABER试验、大转子触诊、抗阻髋关节外展以及抗阻外旋试验对GTPS具有最高的诊断准确性。有症状和无症状女性在MRI上均可见肌腱病变。
