Borms Dorien, Van Bladel Anke, Steyaert Adelheid, Hougs Kjær Birgitte, Maenhout Annelies
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium.
J Shoulder Elbow Surg. 2025 Jul;34(7):e601-e609. doi: 10.1016/j.jse.2024.10.014. Epub 2024 Dec 17.
Literature assessing elasticity in rotator cuff (RC) muscles with shear wave elastography (SWE) is growing but little is known about the overall measurement properties. However, this information is crucial before implementation in research or practice. The objective of this review was first, to systematically investigate the evidence regarding reliability and validity of RC muscles SWE. Second, to summarize measurement protocols to support uniformity and standardization of SWE methodology.
A literature search was conducted using Medline (PubMed), Web of Science, and Embase. Included studies reported measurement properties of reliability, validity, and/or responsiveness of SWE to evaluate RC muscle stiffness in subjects without and with musculoskeletal shoulder pain. Methodological quality was rated with the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. The level of evidence (LoE) was determined using a best-evidence synthesis approach.
Forty-two articles were included. Studies assessing reliability (n = 29) had a moderate LoE for positive ratings of intratester reliability for supraspinatus, infraspinatus, and teres minor and intertester reliability for supraspinatus and infraspinatus. A limited LoE for positive ratings was implied for intertester reliability of teres minor and unknown LoE for negative ratings for day-to-day variability of supraspinatus. Studies reporting on convergent validity (n = 13) showed inconsistent correlation between SWE and other outcomes. Studies assessing discriminant validity (n = 18) showed higher SWE in shoulder patients but not in frozen shoulder and RC tears. Studies reporting on responsiveness (n = 10) showed decreased SWE values 1-2 months postoperatie RC repair and after stretching.
Although RC muscle SWE measurements showed overall moderate reliability, few studies used appropriate reliability study designs and protocols. The evidence regarding convergent validity, discriminant validity, and responsiveness is inconsistent, underscoring the need to improve measurement procedures and explore day-to-day reliability. SWE is a potentially valuable technique for RC muscle assessment. However, future high-quality methodological research with reliability and validity as a primary focus is needed to better understand its applicability in clinical practice.
利用剪切波弹性成像（SWE）评估肩袖（RC）肌肉弹性的文献日益增多，但对其整体测量特性了解甚少。然而，在研究或临床实践中应用之前，这些信息至关重要。本综述的目的，一是系统研究关于RC肌肉SWE可靠性和有效性的证据；二是总结测量方案，以支持SWE方法的一致性和标准化。
使用Medline（PubMed）、Web of Science和Embase进行文献检索。纳入的研究报告了SWE评估无肌肉骨骼性肩部疼痛和有肌肉骨骼性肩部疼痛受试者RC肌肉僵硬度的可靠性、有效性和/或反应性的测量特性。采用基于共识的健康测量工具选择标准清单对方法学质量进行评分。使用最佳证据综合方法确定证据水平（LoE）。
共纳入42篇文章。评估可靠性的研究（n = 29）对于冈上肌、冈下肌和小圆肌的测试者内可靠性的阳性评级以及冈上肌和冈下肌的测试者间可靠性具有中等证据水平。小圆肌的测试者间可靠性的阳性评级证据有限，冈上肌日常变异性的阴性评级证据水平未知。报告收敛效度的研究（n = 13）显示SWE与其他结果之间的相关性不一致。评估区分效度的研究（n = 18）显示肩部患者的SWE较高，但在冻结肩和RC撕裂患者中并非如此。报告反应性的研究（n = 10）显示RC修复术后1 - 2个月以及拉伸后SWE值降低。
尽管RC肌肉SWE测量总体显示出中等可靠性，但很少有研究使用适当的可靠性研究设计和方案。关于收敛效度、区分效度和反应性的证据不一致，突出了改进测量程序和探索日常可靠性的必要性。SWE是一种用于RC肌肉评估的潜在有价值的技术。然而，未来需要以可靠性和有效性为主要重点的高质量方法学研究，以更好地了解其在临床实践中的适用性。
