Tran Gui, Hensor Elizabeth M A, Kingsbury Sarah R, O'Connor Philip, Cowling Paul, Conaghan Philip G
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Department of Rheumatology, Harrogate and District NHS Foundation Trust, Harrogate, UK.
Rheumatology (Oxford). 2024 Aug 1;63(8):2162-2169. doi: 10.1093/rheumatology/kead546.
Shoulder pain is common but current clinical classification has limited utility. We aimed to determine whether groups of ultrasound-based shoulder pathologies exist and to evaluate outcomes according to identified groups and individual pathologies.
This was a prospective study of a community-based cohort with shoulder pain referred for their first ultrasound scan at a single radiology unit, with subsequent routine clinical care. Patient-reported outcomes were collected at baseline, 2 weeks and 6 months; standardized ultrasound reporting was employed. Latent class analysis (LCA) identified ultrasound pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and Shoulder Pain and Disability Index (SPADI). Short-term response to corticosteroid injections was investigated.
Of 500 participants (mean age 53.6 years; 52% female), 330 completed follow-up. LCA identified four groups: bursitis with (33%) or without (27%) acromioclavicular joint degeneration, rotator cuff tear (21%) and no bursitis/tear (19%). Total SPADI was higher at baseline for cuff tears (mean 55.1 vs 49.7-51.3; overall P = 0.005), but accounting for this, groups did not differ at 6 months (43.5 vs 38.5-40.5; P = 0.379). Baseline SPADI was the only predictor of 6-month SPADI retained by penalized modelling; neither LCA-derived ultrasound groups nor individual pathologies were selected. Response to baseline injection at week 2 did not differ between groups (mean SPADI 40.1-43.8; P = 0.423).
Ultrasound-based classification (groups or individual pathologies) of shoulder pain did not predict medium-term outcomes using current treatments. The role of routine diagnostic ultrasound for shoulder pain needs consideration; it may be useful to establish evidence-based therapies for specific pathologies.
肩部疼痛很常见，但目前的临床分类实用性有限。我们旨在确定基于超声的肩部病变分组是否存在，并根据确定的分组和个体病变评估结果。
这是一项对社区队列的前瞻性研究，这些患者因肩部疼痛首次在单一放射科接受超声检查，并接受后续常规临床护理。在基线、2周和6个月时收集患者报告的结果；采用标准化超声报告。潜在类别分析（LCA）确定基于超声病变的分组。多元线性回归分析探讨基线病变、后续治疗与肩痛和功能障碍指数（SPADI）之间的关联。研究了皮质类固醇注射的短期反应。
500名参与者（平均年龄53.6岁；52%为女性）中，330名完成随访。LCA确定了四组：伴有（33%）或不伴有（27%）肩锁关节退变的滑囊炎、肩袖撕裂（21%）和无滑囊炎/撕裂（19%）。肩袖撕裂在基线时的总SPADI较高（平均55.1对49.7 - 51.3；总体P = 0.005），但考虑到这一点，各分组在6个月时无差异（43.5对38.5 - 40.5；P = 0.379）。基线SPADI是通过惩罚模型保留的6个月SPADI的唯一预测因素；LCA衍生的超声分组和个体病变均未被选中。各组在第2周对基线注射的反应无差异（平均SPADI 40.1 - 43.8；P = 0.423）。
基于超声的肩部疼痛分类（分组或个体病变）无法预测当前治疗的中期结果。需要考虑常规诊断超声在肩部疼痛中的作用；为特定病变建立循证治疗方法可能会有用。
