Hall J, Dudgeon B, Guthrie M
Seattle VA Medical Center, Washington 98108, USA.
Am J Occup Ther. 1995 Jun;49(6):526-33. doi: 10.5014/ajot.49.6.526.
Shoulder subluxation after cerebrovascular accident has been associated with chronic pain, orthopedic complications, peripheral nerve damage, and autonomic dysfunction. Clinical diagnosis and gradation of subluxation is problematic due to the lack of precision in frequently used measures. The objective of this study was to assess the validity of clinical techniques used to assess inferior subluxation of the hemiplegic shoulder by comparing these techniques with radiographic measurement.
In 20 male subjects with hemiplegia, the presence, type, and degree of subluxation was assessed with three clinical measures: palpation, arm length discrepancy, and thermoplastic jig measurement. Anterior-posterior X rays of the hemiplegic shoulder were taken after clinical examination.
Spearman rank correlation coefficients between the X rays and the three clinical measures were relatively low. Palpation had the highest correlation (rs = .76), followed by arm length discrepancy (rs = .46), and thermoplastic jig measurement (rs = .42).
These findings provide cautious optimism about using these clinical measures to identify subluxation. Although detection was best with palpation, the likely inability to determine clinical overcorrecting of subluxation makes use of palpation alone suspect. Improved techniques of arm length measurement may provide a solution to this problem. These findings further necessitate that improved procedures for clinical assessment of subluxation be developed.
脑血管意外后肩部半脱位与慢性疼痛、骨科并发症、周围神经损伤及自主神经功能障碍相关。由于常用测量方法缺乏精确性，半脱位的临床诊断和分级存在问题。本研究的目的是通过将这些技术与影像学测量进行比较，评估用于评估偏瘫肩下脱位的临床技术的有效性。
对20名男性偏瘫患者，采用三种临床测量方法评估半脱位的存在、类型和程度：触诊、臂长差异和热塑性夹具测量。临床检查后拍摄偏瘫肩的前后位X线片。
X线与三种临床测量方法之间的Spearman等级相关系数相对较低。触诊的相关性最高（rs = 0.76），其次是臂长差异（rs = 0.46）和热塑性夹具测量（rs = 0.42）。
这些发现为使用这些临床测量方法来识别半脱位提供了谨慎的乐观态度。虽然触诊检测效果最佳，但可能无法确定半脱位的临床过度矫正情况，使得单独使用触诊值得怀疑。改进的臂长测量技术可能为解决这一问题提供方法。这些发现进一步表明需要开发改进的半脱位临床评估程序。
