Department of Orthopaedic Surgery, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT.
Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx.
J Pediatr Orthop. 2020 Oct;40(9):536-542. doi: 10.1097/BPO.0000000000001608.
Ligamentous laxity testing using the Beighton score is frequently used as part of the pediatric shoulder examination. However, the relationship between generalized ligamentous laxity (GLL) and shoulder range of motion (ROM) remains unexamined in children, and normative data for these clinical tests have not been well established. In this study, we establish normative data for shoulder range of motion and GLL in a healthy, diverse pediatric population and investigate whether Beighton testing correlates with shoulder ROM in children.
Healthy subjects age 2 to 18 years with isolated lower extremity complaints were recruited. Passive shoulder ROM measurements for forward flexion (FF), abduction (ABD), internal rotation (IR), external rotation (ER), and extension (EXT) were obtained using a long-armed goniometer. The Beighton score was obtained, with a positive test defined as ≥5. Descriptive statistics were used to stratify data on the basis of age and sex. Interclass correlation coefficients (ICCs) were calculated. Spearman's r was calculated to determine correlations between the Beighton score and shoulder ROM. Predictive indices of a positive Beighton test to identify patients with high shoulder mobility (ROM in the top 15 percentile, or 1 SD above the mean) were calculated.
A total of 202 subjects were enrolled and evaluated. Passive ROM norms by age and sex were determined. Intraclass correlation coefficients for all shoulder ROM measurements were substantial to excellent. Female individuals had greater ROM than age-matched male individuals, but this trend was largely statistically insignificant. Pearson's correlation between age and shoulder ROM was significant for FF, ABD, EXT, and ER (r=-0.52 to -0.20, P<0.001). Based on a Beighton score of ≥5, the prevalence of GLL was 10% in male and 15% in female individuals. Spearman's correlation between Beighton score and shoulder ROM was significant for 3 of 5 ROM measurements: FF, ER, and EXT (r=0.30 to 0.39, P<0.001).
Normative pediatric shoulder ROM and joint laxity data have been established in a healthy, diverse population of children. Beighton testing exhibits only a weak to moderate correlation, despite statistical significance, with shoulder ROM and is poorly predictive for high ROM in children.
Level I- Diagnostic.
Beighton 评分法常用于儿童肩部检查，用于评估韧带松弛度。然而，在儿童中，广泛性韧带松弛（GLL）与肩部活动范围（ROM）之间的关系尚未得到检验，这些临床测试的正常值也尚未得到很好的建立。本研究旨在建立健康、多样化的儿科人群的肩部活动范围和 GLL 的正常值，并探讨 Beighton 测试与儿童肩部 ROM 是否相关。
招募年龄在 2 至 18 岁、仅存在下肢症状的健康受试者。使用长臂量角器测量肩关节前屈（FF）、外展（ABD）、内旋（IR）、外旋（ER）和伸展（EXT）的被动 ROM。获得 Beighton 评分，阳性测试定义为≥5 分。基于年龄和性别对数据进行描述性统计分析。计算组内相关系数（ICC）。采用 Spearman's r 计算 Beighton 评分与肩部 ROM 之间的相关性。计算阳性 Beighton 测试预测高肩部活动度（ROM 在最高 15%或均值加 1 个标准差以上）的预测指标。
共纳入 202 名受试者进行评估。确定了按年龄和性别划分的被动 ROM 正常值。所有肩部 ROM 测量的 ICC 均为中至高。女性的 ROM 大于年龄匹配的男性，但这一趋势在统计学上意义不大。FF、ABD、EXT 和 ER 的年龄与肩部 ROM 之间的 Pearson 相关性均具有统计学意义（r=-0.52 至-0.20，P<0.001）。根据 Beighton 评分≥5，男性 GLL 的患病率为 10%，女性为 15%。Beighton 评分与 5 项 ROM 测量中的 3 项（FF、ER 和 EXT）之间的 Spearman 相关性具有统计学意义（r=0.30 至 0.39，P<0.001）。
在健康、多样化的儿童人群中建立了儿童肩部 ROM 和关节松弛的正常值。尽管具有统计学意义，但 Beighton 测试与肩部 ROM 仅存在弱到中度相关性，且对儿童高 ROM 的预测能力较差。
I 级-诊断。
