Aagaard Knut E, Hänninen Jonas, Abu-Zidan Fikri M, Lunsjö Karl
Department of Orthopedics, Skånevård Sund, Region Skåne, Sweden.
Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Eur J Trauma Emerg Surg. 2018 Oct;44(5):735-745. doi: 10.1007/s00068-017-0883-6. Epub 2017 Nov 29.
Early diagnosis of traumatic acute full-thickness rotator cuff tears (FTRCT) is important to offer early surgical repair. Late repairs following fatty infiltration of the rotator cuff muscles have less favorable results. We think that physical therapists are valuable diagnosticians in a screening process. The objective of this study was to evaluate the usefulness of physical therapists as first-line diagnosticians in detecting acute traumatic FTRCT.
Between November 2010 and January 2014, 394 consecutive patients having an age between 18 and 75 years who sought medical care because of acute shoulder trauma with acute onset of pain, limited abduction and negative plain radiographs were included in the study. A clinical assessment was conducted by a physical therapist 1 week after the trauma. The patients were divided into three groups by the physical therapist according to the findings: FTRCT (Group I, n = 122); sprain (Group II, n = 62); or other specific diagnoses (Group III, n = 210). Group III patients were discharged and excluded from the study. Magnetic Resonance Imaging shoulder was performed for all Group I patients and for all patients with persistent symptoms in Group II.
79/184 patients had FTRCTs documented by MRI in groups I and II. The clinical assessment of the physical therapist had a sensitivity of 85%, specificity of 68%, and usefulness index of 0.45 (> 0.35 considered useful) for diagnosing FTRCT.
Physical therapists can be useful as first-line diagnosticians in detecting traumatic FTRCT.
创伤性急性全层肩袖撕裂（FTRCT）的早期诊断对于早期手术修复很重要。肩袖肌肉脂肪浸润后的延迟修复效果较差。我们认为物理治疗师在筛查过程中是有价值的诊断人员。本研究的目的是评估物理治疗师作为一线诊断人员检测急性创伤性FTRCT的有效性。
2010年11月至2014年1月期间，纳入394例年龄在18至75岁之间因急性肩部创伤伴急性疼痛发作、外展受限且X线平片阴性而寻求医疗护理的连续患者。创伤1周后由物理治疗师进行临床评估。物理治疗师根据检查结果将患者分为三组：FTRCT（I组，n = 122）；扭伤（II组，n = 62）；或其他特定诊断（III组，n = 210）。III组患者出院并被排除在研究之外。对所有I组患者以及II组中所有有持续症状的患者进行肩部磁共振成像检查。
I组和II组中有79/184例患者经MRI证实存在FTRCT。物理治疗师的临床评估对FTRCT诊断的敏感性为85%，特异性为68%，有用性指数为0.45（> 0.35认为有用）。
物理治疗师可作为检测创伤性FTRCT的一线诊断人员。
