Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Sweden.
Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Sweden.
Physiotherapy. 2021 Sep;112:113-120. doi: 10.1016/j.physio.2020.10.001. Epub 2020 Oct 13.
The primary aim was to describe the variability within clinical presentation of patients with subacromial pain in primary care, secondly to investigate associations between clinical presentation and self-reported pain intensity, shoulder function, level of anxiety and depression, and health-related quality of life.
A cross-sectional study based on data from two clinical studies in primary care, one randomized controlled trial and one implementation study. Three components: active range of motion (AROM), rotator cuff function and scapular kinematics were analyzed to describe variability within clinical presentation and patient-reported measurements were used to investigate the impact on daily life.
Patients aged 30-67 years, describing pain for more than two weeks, with positive signs for a minimum of three out of the following five clinical tests: impingement sign according to Neer, impingement test according to Hawkins-Kennedy, Pattes maneuver, Jobe's test, and painful arc.
Among the 164 patients included, 24% displayed dysfunction in one, 50% two and 24% in all three components. Limited AROM was seen in 46%, rotator cuff dysfunction in 91% and scapular dyskinesia in 57% of the patients.
These results reveal a heterogeneity among primary care patients with subacromial pain confirming a large variability regarding the components AROM, rotator cuff function and scapular kinematics. All three components appear unique (not significantly correlated) where a rotator cuff dysfunction is very frequent while limited AROM and scapular dyskinesia are more inconsistent. There are significant, but rather weak, associations between clinical presentation and impact on daily life.
本研究旨在描述初级保健中肩峰下疼痛患者临床表现的变异性，其次，探讨临床表现与自我报告的疼痛强度、肩部功能、焦虑和抑郁水平以及健康相关生活质量之间的关联。
本研究为基于初级保健中两项临床研究（一项随机对照试验和一项实施研究）数据的横断面研究。分析主动活动度（AROM）、肩袖功能和肩胛骨运动学三个组成部分，以描述临床表现的变异性，并使用患者报告的测量值来研究对日常生活的影响。
年龄在 30-67 岁之间，疼痛持续时间超过两周，具有以下五项临床检查中至少三项阳性体征的患者：根据 Neer 诊断的撞击征、根据 Hawkins-Kennedy 诊断的撞击试验、Pattes 手法、Jobe 试验和疼痛弧。
在纳入的 164 例患者中，24%的患者存在一个组成部分的功能障碍，50%的患者存在两个组成部分的功能障碍，24%的患者存在三个组成部分的功能障碍。46%的患者存在活动度受限，91%的患者存在肩袖功能障碍，57%的患者存在肩胛骨运动障碍。
这些结果表明初级保健中肩峰下疼痛患者存在异质性，证实了 AROM、肩袖功能和肩胛骨运动学三个组成部分存在较大的变异性。这三个组成部分似乎是独特的（无显著相关性），其中肩袖功能障碍非常常见，而活动度受限和肩胛骨运动障碍则更为不一致。临床表现与日常生活影响之间存在显著但较弱的关联。
