Beer Yiftah, Gilat Ron, Ner Eran Beit, Shohat Noam, Atoun Ehud, Lindner Dror, Agar Gabriel
Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel.
Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2021 Feb 24;9(2):2325967120985643. doi: 10.1177/2325967120985643. eCollection 2021 Feb.
The physical examination of overweight patients can require specific adaptations. Orthopaedic literature on the impact of body mass index (BMI) on the physical examination of the shoulder is virtually nonexistent.
To assess whether BMI affects the sensitivity and specificity of common shoulder tests, using arthroscopy as a gold standard. We also examined the effects of BMI on the sensitivity and specificity of magnetic resonance imaging (MRI) of the shoulder for reference.
Cohort study (diagnosis); Level of evidence, 2.
We analyzed the data of 116 consecutive patients who underwent shoulder arthroscopy for the treatment of rotator cuff tears, Bankart lesions, and superior labral anterior-posterior (SLAP) lesions. Preoperative BMI, physical examination of the shoulder findings, and MRI findings were extracted. Contingency tables and receiver operating characteristic curves were used to evaluate the sensitivity and specificity of provocative tests of the shoulder and MRI as well as their relationship to BMI.
The sensitivity and specificity of the Jobe supraspinatus test were 77.8% and 72.7% in patients with BMI ≤25, 82.6% and 70.6% in those with 25 < BMI ≤ 30, and 81.3% and 55.6% in those with BMI >30, respectively ( < .001). The apprehension and relocation tests demonstrated higher sensitivity and specificity for the overweight patients (25 < BMI ≤ 30) compared with the other BMI groups, with a sensitivity and specificity of 83.3% and 100% for the apprehension test and a sensitivity and specificity of 75% and 100% for the relocation test, respectively. The O'Brien, Speed, and Ebinger tests for SLAP tears had low accuracy and did not yield statistically significant results. MRI interpretation was found to be influenced by BMI in obese patients, especially when SLAP lesions were assessed.
Counterintuitively, tests for shoulder instability had greater specificity in overweight patients and should be encouraged, particularly in obese patients, in whom the specificity of shoulder MRI for the detection of a Bankart lesion is lower. The Jobe test was more sensitive but less specific in overweight patients. These findings may assist care providers in improving the interpretation of the shoulder examination of overweight patients and consequently lead to better treatment-related decisions.
对超重患者进行体格检查可能需要进行特定调整。骨科文献中几乎没有关于体重指数（BMI）对肩部体格检查影响的内容。
以关节镜检查为金标准，评估BMI是否会影响常见肩部检查的敏感性和特异性。我们还研究了BMI对肩部磁共振成像（MRI）敏感性和特异性的影响以供参考。
队列研究（诊断）；证据等级，2级。
我们分析了116例连续接受肩部关节镜检查以治疗肩袖撕裂、Bankart损伤和上盂唇前后部（SLAP）损伤患者的数据。提取术前BMI、肩部体格检查结果和MRI结果。使用列联表和受试者工作特征曲线来评估肩部激发试验和MRI的敏感性、特异性以及它们与BMI的关系。
BMI≤25的患者中，Jobe冈上肌试验的敏感性和特异性分别为77.8%和72.7%；25＜BMI≤30的患者中，分别为82.6%和70.6%；BMI＞30的患者中，分别为81.3%和55.6%（P＜0.001）。与其他BMI组相比，恐惧试验和复位试验在超重患者（25＜BMI≤30）中表现出更高的敏感性和特异性，恐惧试验的敏感性和特异性分别为83.3%和100%，复位试验的敏感性和特异性分别为75%和100%。用于检测SLAP撕裂的O'Brien试验、Speed试验和Ebinger试验准确性较低，未得出具有统计学意义的结果。发现MRI解读在肥胖患者中受BMI影响，尤其是在评估SLAP损伤时。
与直觉相反，肩部不稳定试验在超重患者中具有更高的特异性，应予以鼓励，特别是在肥胖患者中，此时肩部MRI检测Bankart损伤的特异性较低。Jobe试验在超重患者中更敏感但特异性较低。这些发现可能有助于医护人员更好地解读超重患者的肩部检查结果，从而做出更好的治疗相关决策。
