Balevi Batur Elif, Bekin Sarıkaya Pelin Zeynep, Kaygısız Mustafa Emin, Albayrak Gezer Ilknur, Levendoglu Funda
Physical Medicine and Rehabilitation, Selcuk University Faculty of Medicine, Konya, TUR.
Radiology, Kırıkkale University Faculty of Medicine, Kırıkkale, TUR.
Cureus. 2022 Jun 13;14(6):e25903. doi: 10.7759/cureus.25903. eCollection 2022 Jun.
The study aims to investigate the diagnostic accuracy of five clinical shoulder tests in the diagnosis of supraspinatus tears and tendinosis when compared to magnetic resonance imaging (MRI).
A total of 116 shoulders of 106 consecutive patients who experienced shoulder pain were assessed for this cross-sectional diagnostic accuracy study. Patients were assessed with the most commonly used clinical shoulder tests, including the Jobe test (empty can), Neer test, drop arm test, Hawkins test, and full can test to identify supraspinatus tears and tendinosis. MRI examinations were performed on a 1.5 Tesla MRI system, and images were assessed by a blinded radiologist. The primary outcomes were to determine the sensitivity, specificity, and accuracy of the five clinical tests and to establish their correlation with MRI for supraspinatus tears and tendinosis.
The Hawkins test had a higher sensitivity and accuracy when diagnosing tears (sensitivity 89.66% [95% CI, 78.83-96.11] and accuracy 56.03% [95% CI, 46.51-65.23], respectively) and higher sensitivity in tendinosis (79.07% [95% CI, 63.96-89.96]). The drop arm test had a lower sensitivity but higher specificity in both tendinosis and tears (sensitivity 0% [95% CI, 0-8.22] and 12.07% [95% CI, 4.99-23.29], respectively, and specificity 87.67% [95% CI, 77.88-94.21] and 96.5% [95% CI, 88.09-99.58], respectively). The Neer test had a higher positive predictive value (PPV) of 37.21% in diagnosing tendinosis. When compared to the Hawkins test, the combination of the clinical tests had no statistically significant contribution to sensitivity and diagnostic accuracy.
The Hawkins test had higher accuracy in diagnosing tears and was the most sensitive in diagnosing supraspinatus tendinosis and tears when compared to the MRI findings. The Neer test may also be another reliable tool for the diagnosis of tendinosis due to its higher PPV.
本研究旨在探讨五项临床肩部检查与磁共振成像（MRI）相比，在诊断冈上肌撕裂和肌腱病方面的诊断准确性。
对连续106例肩部疼痛患者的116个肩部进行了这项横断面诊断准确性研究。对患者进行了最常用的临床肩部检查，包括乔布试验（空罐试验）、尼尔试验、落臂试验、霍金斯试验和全罐试验，以确定冈上肌撕裂和肌腱病。在1.5特斯拉MRI系统上进行MRI检查，图像由一名不知情的放射科医生评估。主要结果是确定五项临床检查的敏感性、特异性和准确性，并确定它们与MRI诊断冈上肌撕裂和肌腱病的相关性。
霍金斯试验在诊断撕裂时具有较高的敏感性和准确性（敏感性分别为89.66%[95%CI，78.83 - 96.11]和准确性为56.03%[95%CI，46.51 - 65.23]），在诊断肌腱病时具有较高的敏感性（79.07%[95%CI，63.96 - 89.96]）。落臂试验在肌腱病和撕裂中的敏感性较低，但特异性较高（在肌腱病和撕裂中的敏感性分别为0%[95%CI，0 - 8.22]和12.07%[95%CI，4.99 - 23.29]，特异性分别为87.67%[95%CI，77.88 - 94.21]和96.5%[95%CI，88.09 - 99.58]）。尼尔试验在诊断肌腱病时具有较高的阳性预测值（PPV），为37.21%。与霍金斯试验相比，临床检查的联合对敏感性和诊断准确性没有统计学上的显著贡献。
与MRI结果相比，霍金斯试验在诊断撕裂时准确性更高，在诊断冈上肌腱病和撕裂时最敏感。由于尼尔试验具有较高的PPV，它也可能是诊断肌腱病的另一种可靠工具。
