Department of Orthopedics and Traumatology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt.
J Shoulder Elbow Surg. 2020 Jan;29(1):95-103. doi: 10.1016/j.jse.2019.05.038. Epub 2019 Aug 27.
The literature has reported debatable diagnostic accuracy of clinical provocative tests for a type II superior labral anteroposterior (SLAP) lesion, especially in the context of a type V SLAP (concurrent Bankart and type II SLAP) lesion. This study was conducted to determine whether the investigated provocative tests offer reliable predictive values in the diagnosis of type II SLAP lesions in patients with recurrent anterior glenohumeral (GH) instability.
This prospective case-control study carried out between September 2014 and September 2018 included 51 patients with post-traumatic recurrent anterior GH instability. Patients were prospectively evaluated for type II SLAP lesions by 9 provocative tests: Jobe relocation test, abduction-external rotation test, anterior slide test, biceps load test I, biceps load test II, pain provocation test, labral tension test, crank test, and the O'Driscoll dynamic labral shear test. The results of these tests were compared with findings of diagnostic arthroscopic GH examinations (control).
Statistical analysis revealed the mean age of the studied group to be 26.1 ± 7.56 years, with male predominance (50 patients; 98.04%). Arthroscopic examination revealed a Bankart lesion in isolation and in association with a type II SLAP lesion (ie, a type V SLAP lesion) in 15 (29.4%) and 36 (70.6%) patients, respectively. The anterior slide test yielded the highest positive and lowest negative likelihood ratios (2.91 and 0.52, respectively).
Except for the anterior slide test, which can be validated for the clinical diagnosis of type II SLAP lesions in patients with traumatic recurrent anterior GH instability, the investigated tests offer poor predictive values and should be cautiously used in clinical practice.
文献报道，对于 II 型前上盂唇前后向（SLAP）病变的临床激发试验的诊断准确性存在争议，尤其是在 V 型 SLAP（Bankart 病变合并 II 型 SLAP 病变）病变的情况下。本研究旨在确定在复发性前肩盂肱（GH）不稳定患者中，所研究的激发试验是否对 II 型 SLAP 病变的诊断具有可靠的预测值。
这是一项在 2014 年 9 月至 2018 年 9 月间进行的前瞻性病例对照研究，共纳入 51 例创伤后复发性前 GH 不稳定患者。前瞻性评估 9 种激发试验对 II 型 SLAP 病变的诊断价值：Jobe 复位试验、外展外旋试验、前滑试验、二头肌负荷试验 I、二头肌负荷试验 II、疼痛激发试验、盂唇张力试验、曲柄试验和 O'Driscoll 动态盂唇剪切试验。将这些试验的结果与诊断性关节镜 GH 检查（对照组）的结果进行比较。
统计分析显示，研究组的平均年龄为 26.1 ± 7.56 岁，男性占优势（50 例；98.04%）。关节镜检查显示，15 例（29.4%）患者孤立存在 Bankart 病变，36 例（70.6%）患者存在 Bankart 病变合并 II 型 SLAP 病变（即 V 型 SLAP 病变）。前滑试验的阳性似然比最高（2.91），阴性似然比最低（0.52）。
除前滑试验外，其他试验对创伤性复发性前 GH 不稳定患者 II 型 SLAP 病变的临床诊断具有一定的验证价值，所研究的试验对诊断 II 型 SLAP 病变的预测价值较低，在临床实践中应谨慎使用。
