Roberts Shaun, Dearne Rebecca, Keen Sally, Littlewood Chris, Taylor Stephanie, Deacon Paula
Integrated Physiotherapy, Orthopaedic and Pain Service, Sir Robert Peel Hospital, Tamworth, UK.
Integrated Physiotherapy, Orthopaedic and Pain Service, Samuel Johnson Hospital, Lichfield, UK.
Musculoskeletal Care. 2019 Jun;17(2):288-292. doi: 10.1002/msc.1396. Epub 2019 Mar 29.
Frozen shoulder is a common condition, and current guidelines state that it is a diagnosis of exclusion. Along with a history and clinical examination, routine X-ray is mandated, to rule out any "masquerading" pathology such as fracture, dislocation, metastatic lesions or severe osteoarthritis. Despite the certainty of the guidelines there is a lack of evidence to support the use of routine X-rays in this situation.
A retrospective review was performed of all X-rays obtained in the diagnosis of frozen shoulder between February 2014 and August 2017 in an integrated musculoskeletal interface service. Results were screened and the prevalence of masquerading pathology was determined.
A total of 350 shoulder X-rays that had been performed for patients with a provisional diagnosis of frozen shoulder were reviewed. Of these, 213 were from female patients (60.9%), the mean age was 57.7 (standard deviation 10.4) years and 342 (97.7%) did not have any concerning features. Six (1.7%) had severe osteoarthritis, one (0.3%) had a fracture and one (0.3%) had a lucency. All eight patients with masquerading pathology had findings from the history and clinical examination which would have warranted an X-ray, regardless of a differential diagnosis of frozen shoulder.
The findings of this retrospective review of a large number of X-rays do not support the requirement of a routine X-ray to rule out masquerading pathology to confirm the diagnosis. The data suggest that it is unnecessary for patients without a relevant clinical history suggestive of serious or masquerading pathology to undergo routine imaging.
肩周炎是一种常见病症，当前指南指出其诊断需排除其他疾病。除病史和临床检查外，还需进行常规X线检查，以排除任何“伪装”的病理情况，如骨折、脱位、转移性病变或严重骨关节炎。尽管指南明确，但缺乏证据支持在这种情况下使用常规X线检查。
对2014年2月至2017年8月在综合肌肉骨骼界面服务中因肩周炎诊断而进行的所有X线检查进行回顾性分析。筛选结果并确定“伪装”病理的患病率。
共回顾了350例初步诊断为肩周炎患者的肩部X线检查。其中，213例来自女性患者（60.9%），平均年龄为57.7岁（标准差10.4），342例（97.7%）没有任何可疑特征。6例（1.7%）患有严重骨关节炎，1例（0.3%）有骨折，1例（0.3%）有透亮区。所有8例有“伪装”病理的患者，无论肩周炎的鉴别诊断如何，其病史和临床检查结果都表明需要进行X线检查。
对大量X线检查的回顾性分析结果不支持通过常规X线检查排除“伪装”病理来确诊肩周炎的必要性。数据表明，对于没有提示严重或“伪装”病理的相关临床病史的患者，进行常规影像学检查是不必要的。
