Department of Physical Therapy, University of Alberta, Edmonton, Canada.
Department of Surgery, University of Alberta, Edmonton, Canada.
Disabil Rehabil. 2020 Aug;42(16):2351-2358. doi: 10.1080/09638288.2018.1563637. Epub 2019 Feb 8.
Shoulder pain causes significant disability, with rotator cuff disease as a common diagnosis. Differentially diagnosing partial tears of the rotator cuff tendons is difficult despite use of imaging and clinical examination. Our objective was to determine if a clinical assessment framework could discriminate between patients with partial and full thickness tears. Pre-operative baseline data from two randomized controlled trials of 452 adult patients awaiting rotator cuff repair were analyzed in this secondary analysis. Nineteen items from a pre-defined clinical assessment framework were investigated for association with the outcome of surgically confirmed partial or full thickness tear. Logistic regression tested independent associations and multivariable models were developed to create the most parsimonious model. Thirty-two participants (7%) had partial thickness tears. Constant Power Score was the sole item associated with partial thickness tears (OR 1.07, 95% CI 1.02-1.12). Traumatic mechanism of injury trended toward significance (OR 2.17, 95% CI 1.06-4.48). Greater abduction strength (i.e., Constant Power Score) was associated with partial thickness tears. Other clinical assessment items did not differentiate between partial and full tears. Our results add to the growing body of research showing most clinical findings are not associated with a diagnosis in rotator cuff disease.Implications for RehabilitationGreater shoulder abduction strength (as measured with the Constant Power Score) was associated with partial thickness rotator cuff tears.Most findings within our clinical assessment framework did not distinguish between partial thickness and full thickness rotator cuff tears and thus, did not contribute to a differential pathoanatomical diagnosis.Since structural integrity of the rotator cuff and patient presentation show poor association, and rehabilitation intervention is often impairment-based, pathoanatomical diagnosis may not adequately direct non-surgical treatment. Including movement-based diagnoses or treatment classification systems in evaluation of rotator cuff disease may improve selection of appropriate conservative treatment.
肩部疼痛会导致显著的残疾，其中肩袖疾病是常见的诊断。尽管使用影像学和临床检查，对肩袖肌腱部分撕裂的鉴别诊断仍具有挑战性。我们的目的是确定临床评估框架是否可以区分部分和全层撕裂的患者。对两项随机对照试验中 452 名等待肩袖修复的成年患者的术前基线数据进行了二次分析。对预定义临床评估框架中的 19 个项目进行了调查，以研究其与手术证实的部分或全层撕裂结果的相关性。逻辑回归检验了独立相关性，并建立多变量模型以创建最简约的模型。32 名参与者（7%）存在部分厚度撕裂。恒力评分是唯一与部分厚度撕裂相关的项目（OR 1.07，95%CI 1.02-1.12）。创伤性损伤机制有向显著相关的趋势（OR 2.17，95%CI 1.06-4.48）。更大的外展力量（即恒力评分）与部分厚度撕裂相关。其他临床评估项目无法区分部分和全层撕裂。我们的结果增加了越来越多的研究结果，这些研究表明，大多数临床发现与肩袖疾病的诊断无关。
康复的意义
更大的肩外展力量（如恒力评分所测量）与肩袖部分撕裂有关。
我们临床评估框架中的大多数发现无法区分肩袖部分厚度和全厚度撕裂，因此无法为差异病理解剖学诊断提供依据。
由于肩袖结构完整性和患者表现之间关联较差，且康复干预通常基于功能障碍，因此病理解剖学诊断可能无法充分指导非手术治疗。在评估肩袖疾病时纳入基于运动的诊断或治疗分类系统可能会改善对适当保守治疗的选择。
