School of Physical Therapy, University of Western Ontario, London, Ontario, Canada.
LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, South Yarra, Victoria, Australia.
Sports Health. 2018 Mar/Apr;10(2):141-145. doi: 10.1177/1941738117752306. Epub 2018 Jan 22.
Posterior glenohumeral instability is poorly understood and can be challenging to recognize and evaluate. Using evidence-based clinical and predictive tests can assist clinicians in appropriate assessment and management.
To review evidence-based clinical diagnostic tests for posterior glenohumeral instability and predictive tests that identify responders to conservative management.
A comprehensive electronic bibliographic search was conducted using Embase, Ovid MEDLINE, PEDro, and CINAHL databases from their date of inception to February 2017.
Studies were included for further review if they (1) reported on clinical diagnostic tests for posterior or posteroinferior instability of the glenohumeral joint, (2) assessed predictive clinical tests for posterior instability of the glenohumeral joint, and (3) were in English.
Systematic review.
Level 4.
Data were extracted from the studies by 2 independent reviewers and included patient demographics and characteristics, index/reference test details (name and description of test), findings, and data available to calculate psychometric properties.
Five diagnostic and 2 predictive studies were selected for review. There was weak evidence for the use of the jerk test, Kim test, posterior impingement sign, and O'Brien test as stand-alone clinical tests for identifying posterior instability. Additionally, there was weak evidence to support the use of the painless jerk test and the hand squeeze sign as predictive tests for responders to conservative management. These findings are attributed to study design limitations, including small and/or nonrepresentative samples.
Clustering of thorough history and physical examination findings, including the aforementioned tests, may identify those with posterior glenohumeral instability and assist in developing management strategies.
后方盂肱关节不稳定的理解不够充分，且其识别和评估具有挑战性。使用基于循证的临床和预测性检查有助于临床医生进行适当的评估和管理。
综述用于评估后方盂肱关节不稳定的基于循证的临床诊断性检查，以及用于识别对保守治疗有反应的预测性检查。
从各数据库的建库时间至 2017 年 2 月，通过全面的电子文献检索，检索了 Embase、Ovid MEDLINE、PEDro 和 CINAHL 数据库。
如果研究（1）报告了盂肱关节后方或后下方不稳定的临床诊断性检查，（2）评估了盂肱关节后方不稳定的预测性临床检查，（3）为英文文献，则纳入进一步的综述。
系统性综述。
4 级。
由 2 名独立评审员从研究中提取数据，包括患者人口统计学和特征、索引/参考测试的详细信息（测试名称和描述）、发现以及可用于计算心理测量特性的数据。
选择了 5 项诊断性研究和 2 项预测性研究进行综述。有弱证据表明，在单独使用时，冲击试验、Kim 试验、后方撞击征和 O'Brien 试验可用于识别后方不稳定。此外，有弱证据支持无痛冲击试验和手挤压征可用于预测对保守治疗有反应的患者。这些发现归因于研究设计的局限性，包括样本小且/或无代表性。
详细的病史和体格检查结果（包括上述检查）的聚类可能会识别出那些患有后方盂肱关节不稳定的患者，并有助于制定管理策略。
