Liu Tiffany C, Leung Nina, Edwards Leonard, Ring David, Bernacki Edward, Tonn Melissa D
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1912 Speedway, Austin, TX, 78712, USA.
Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Clin Orthop Relat Res. 2017 Oct;475(10):2360-2365. doi: 10.1007/s11999-017-5401-y. Epub 2017 Jun 9.
Minor events that occur in the workplace sometimes are evaluated with MRI, which may reveal age-related changes in the symptomatic body part. These age-related changes are often ascribed to the event. However, evidence of similar or worse pathophysiology in the contralateral joint would suggest that the symptoms might be new, but the pathophysiology is not.
QUESTIONS/PURPOSES: Using a convenience sample of occupational injury claimants with bilateral MRI to evaluate unilateral knee or shoulder symptoms ascribed to a single event at work, we sought to determine whether MRI findings of the shoulder and knee are more often congruent or incongruent with new unilateral symptoms.
Two hundred ninety-four occupational injury claimants employed at companies throughout Texas that do not subscribe to workers' compensation insurance, who were older than 40 years, and with unilateral shoulder or knee symptoms, were studied. Starting in 2012, all patients seen by OccMD Group PA who present with unilateral symptoms ascribed to work undergo bilateral MRI, based on several previous occasions where bilateral MRI proved to be a compelling demonstration that perceived injuries are more likely age-related, previously well-adapted pathophysiology. MRI findings (anything described as abnormal by the radiologist; eg, defect size or signal change) was considered congruent if the abnormality of one or more structures on the symptomatic side was greater than that of the corresponding structures in the asymptomatic joint. Bivariate analysis was used to compare the frequency of MRI findings congruent and incongruent with symptoms. Logistic regression was used to evaluate factors associated with MRI findings of the shoulder or knee.
Less than half of the patients with shoulder (90 of 189; 48%; p = 0.36) or knee (45 of 105; 43%; p = 0.038) symptoms had worse pathologic features on the symptomatic side. Older age was associated with disorders in the infraspinatus tendon (59 ± 8 versus 56 ± 8 years; p = 0.012), glenoid labrum (60 ± 9 versus 57 ± 8 years; p = 0.025), and biceps tendon (60 ± 8 versus 57 ± 8 years; p = 0.0038). Eighty-seven percent of patients (91 of 105) had structural changes in the medial meniscus described by the radiologist.
Occupational injury claimants 40 years of age and older with unilateral knee and shoulder symptoms ascribed to a work event tend to have bilateral age-related MRI changes. Age-related disorders should be distinguished from acute injury.
Level IV, diagnostic study.
工作场所发生的轻微事件有时会通过磁共振成像（MRI）进行评估，这可能会揭示有症状身体部位与年龄相关的变化。这些与年龄相关的变化通常被归因于该事件。然而，对侧关节存在类似或更严重病理生理学变化的证据表明，症状可能是新出现的，但病理生理学并非如此。
问题/目的：我们采用便利抽样的方法，选取有双侧MRI检查结果的职业伤害索赔者，以评估因工作中单次事件导致的单侧膝盖或肩膀症状，旨在确定肩膀和膝盖的MRI检查结果与新出现的单侧症状相符或不符的情况哪个更常见。
对294名在德克萨斯州各公司工作、年龄超过40岁且有单侧肩膀或膝盖症状、未参保工伤保险的职业伤害索赔者进行研究。从2012年开始，OccMD Group PA诊治的所有因工作导致单侧症状的患者均接受双侧MRI检查，这是基于此前多次双侧MRI检查有力地证明了所察觉到的损伤更可能与年龄相关，是先前已适应的病理生理学变化。如果有症状一侧一个或多个结构的异常大于无症状关节相应结构的异常，则MRI检查结果（放射科医生描述为异常的任何情况，如缺损大小或信号变化）被认为是相符的。采用双变量分析比较与症状相符和不符的MRI检查结果的频率。使用逻辑回归评估与肩膀或膝盖MRI检查结果相关的因素。
肩膀有症状的患者中不到一半（189例中的90例；48%；p = 0.36）或膝盖有症状的患者中不到一半（105例中的45例；43%；p = （此处原文有误，应为0.038））在有症状一侧有更严重的病理特征。年龄较大与冈下肌腱疾病（59±8岁对56±8岁；p = 0.012）、盂唇（60±9岁对57±8岁；p = 0.025）和肱二头肌肌腱疾病（6（此处原文有误，应为60）±8岁对57±8岁；p = 0.0038）相关。87%的患者（105例中的91例）经放射科医生描述在内侧半月板有结构变化。
40岁及以上因工作事件导致单侧膝盖和肩膀症状的职业伤害索赔者往往有双侧与年龄相关的MRI变化。应将与年龄相关的疾病与急性损伤区分开来。
IV级，诊断性研究。
