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前肩不稳患者的临床评估与体格检查结果

Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability.

作者信息

Lizzio Vincent A, Meta Fabien, Fidai Mohsin, Makhni Eric C

机构信息

Wayne State University, Detroit, MI, USA.

Department of Orthopedic Surgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.

出版信息

Curr Rev Musculoskelet Med. 2017 Dec;10(4):434-441. doi: 10.1007/s12178-017-9434-3.

Abstract

PURPOSE OF REVIEW

The goal of this paper is to provide an overview in evaluating the patient with suspected or known anteroinferior glenohumeral instability.

RECENT FINDINGS

There is a high rate of recurrent subluxations or dislocations in young patients with history of anterior shoulder dislocation, and recurrent instability will increase likelihood of further damage to the glenohumeral joint. Proper identification and treatment of anterior shoulder instability can dramatically reduce the rate of recurrent dislocation and prevent subsequent complications. Overall, the anterior release or surprise test demonstrates the best sensitivity and specificity for clinically diagnosing anterior shoulder instability, although other tests also have favorable sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and inter-rater reliabilities. Anterior shoulder instability is a relatively common injury in the young and athletic population. The combination of history and performing apprehension, relocation, release or surprise, anterior load, and anterior drawer exam maneuvers will optimize sensitivity and specificity for accurately diagnosing anterior shoulder instability in clinical practice.

摘要

综述目的

本文旨在概述对疑似或已知存在肩肱关节前下不稳患者的评估。

最新发现

有前肩脱位病史的年轻患者复发性半脱位或脱位发生率较高,而复发性不稳会增加肩肱关节进一步损伤的可能性。正确识别和治疗前肩不稳可显著降低复发性脱位的发生率并预防后续并发症。总体而言,前释放试验或惊奇试验对临床诊断前肩不稳的敏感性和特异性最佳,不过其他试验也具有良好的敏感性、特异性、阳性似然比、阴性似然比及评分者间信度。前肩不稳在年轻且活跃的人群中是一种相对常见的损伤。结合病史并进行恐惧试验、复位试验、释放试验或惊奇试验、前负荷试验及前抽屉试验等手法,将优化在临床实践中准确诊断前肩不稳的敏感性和特异性。

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