Department of Rehabilitation Center, Tokyo Medical University, Japan.
Department of Orthopedic Surgery, Tokyo Medical University, Japan.
J Orthop Sci. 2024 Sep;29(5):1179-1182. doi: 10.1016/j.jos.2023.09.003. Epub 2023 Oct 14.
Dropped head syndrome (DHS) is followed by severe cervical extension muscle weakness that results in chin-on chest deformity. However, maintaining a neutral cervical position can be temporarily possible, and the diagnosis of DHS might sometimes be difficult. The purpose of the present study is to examine a novel clinical test (DHS test) as the diagnostic utility for objective evaluation that focuses on cervical extension condition in the prone position.
One hundred subjects were diagnosed with isolated neck extensor myopathy (INEM)-DHS at our hospital (17 men and 83 women, mean age 75.0 ± 8.5 years), and 62 subjects were enrolled as age-matched controls. The DHS test consisted of three examinations; the first was "Ceiling gazing test" in standing position, the second was horizontal gazing in "Sphinx prone position test", and the third was horizontal gazing in "Hands and knees prone position test". We investigated the sensitivity and specificity of the DHS test for DHS.
The patients showing positive in the INEM-DHS group were 63/100 in Ceiling gaze test, 73/100 in the Sphinx prone position test, and 91/100 in the Hands and knees prone position test. In the control group, 0/62 patients presented positive in the Ceiling gaze test, 4/62 in the Sphinx prone position test, and 0/62 in the Hands and knees prone position test. Sensitivity and specificity of the DHS test were 63.0%/100%, 73.0%/93.5%, and 91.0%/100% in the Ceiling gaze test, Sphinx position prone position test, and Hands and knees prone position test, respectively.
The prone position cervical extension test (DHS test) would be useful as a novel objective diagnostic tool for INEM-DHS.
垂头综合征（DHS）可导致严重的颈伸肌无力，从而导致下巴贴近胸部的畸形。然而，保持颈椎中立位暂时是可能的，因此 DHS 的诊断有时可能较为困难。本研究旨在探讨一种新的临床检查（DHS 试验）作为客观评估的诊断工具，该检查侧重于颈椎在俯卧位的伸展状态。
我院共诊断出 100 例孤立性颈伸肌病-DHS 患者（17 名男性，83 名女性，平均年龄 75.0±8.5 岁），并纳入 62 名年龄匹配的对照组。DHS 试验包括三个检查，第一个是站立位的“仰头检查”，第二个是 Sphinx 俯卧位试验中的水平凝视，第三个是 Hands and Knees 俯卧位试验中的水平凝视。我们调查了 DHS 试验对 DHS 的敏感性和特异性。
在 INEM-DHS 组中，63/100 例患者在仰头检查中呈阳性，73/100 例患者在 Sphinx 俯卧位试验中呈阳性，91/100 例患者在 Hands and Knees 俯卧位试验中呈阳性。在对照组中，0/62 例患者在仰头检查中呈阳性，4/62 例患者在 Sphinx 俯卧位试验中呈阳性，0/62 例患者在 Hands and Knees 俯卧位试验中呈阳性。仰头检查、 Sphinx 位俯卧位检查和 Hands and Knees 俯卧位检查的 DHS 试验的敏感性和特异性分别为 63.0%/100%、73.0%/93.5%和 91.0%/100%。
俯卧位颈椎伸展试验（DHS 试验）可作为 INEM-DHS 的一种新的客观诊断工具。
