Lerat J L, Chotel F, Besse J L, Moyen B, Brunet Guedj E
Service de Chirurgie Orthopédique et de Médecine du Sport, Hôpital E. Herriot, Lyon.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(6):461-7.
A new clinical test named "The shoulder anterior jerk test" is proposed to confirm the diagnosis of chronic shoulder anterior instability.
The test combines of a compression force and a translation force, applied along the arm between the humeral head and the glenoid cavity. In so doing, a subluxation of the humeral head is provoked and it is accompanied with a jerk recognised by the patient as his instability.
Three different populations of patients had been studied: Population A: 28 patients operated on for chronic anterior dislocation, uni or bilateral (32 shoulders), had been tested before the operation, without and under anesthesia. Population B: 100 patients without any problem at the shoulder, had been tested before and under anesthesia done for knee or hip surgery. Population C: 100 young sportive athletes with normal shoulder tested without anesthesia.
Population A: The 28 patients suffering from shoulder instability had all a positive shoulder jerk test under anesthesia. Without anesthesia the test had been positive only in 10 cases (30 per cent). The jerk is potentially present for all the patients, but it is disturbed by apprehension. Population B: Among the 200 shoulders tested, 26 shoulders (17 patients) had a positive test under anesthesia (13 per cent). 5 had positive jerk test without anesthesia. Population C: 5 among the 200 shoulders tested had a positive jerk test (2.5 per cent) Under anesthesia the test has a sensitivity of 100 per cent, a specificity of 87 per cent, a positive predictive value of 55 per cent and a negative value of 100 per cent. Without anesthesia, the test has a sensitivity of 31 per cent, a specificity of 97.5 per cent, a positive predictive value of 66 per cent and a negative predictive value of 90 per cent.
The instability which is shown by the jerk test is in relation with the anterior subluxation of the humeral head in front of the anterior edge of the glenoïd cavity. It reproducts, with a minimal amplitude, the clinical instability which is recognized by the patient. The test is always positive under anesthesia in case of chronic anterior instability, it may confirm pre-operative diagnosis just before the begining of the procedure and may orientate the choice of it. Apprehension is a major obstacle to the research of the jerk, but it is the same with the other classical clinical tests of the shoulder anterior instability.
The anterior jerk test of the shoulder is thus a test which is able to prove the diagnosis of an anterior instability. The future will permit to confirm its efficiency and will confirm if the test may differenciate anterior and inferior instability with variation of the abduction, as it has been shown in this preliminary study.
提出一种名为“肩部前冲试验”的新临床测试，以确诊慢性肩部前不稳定。
该测试结合了沿手臂在肱骨头和关节盂之间施加的压缩力和平移力。这样做会引发肱骨头半脱位，并伴有患者认为是其不稳定的一种抽动。
研究了三组不同的患者群体：A组：28例因慢性前脱位接受手术的患者，单侧或双侧（32个肩部），在手术前、未麻醉和麻醉状态下均进行了测试。B组：100例肩部无任何问题的患者，在因膝关节或髋关节手术进行麻醉前和麻醉状态下进行了测试。C组：100名肩部正常的年轻运动运动员，未进行麻醉测试。
A组：28例肩部不稳定患者在麻醉状态下肩部前冲试验均为阳性。未麻醉时，该测试仅10例（30%）为阳性。所有患者潜在都存在抽动，但会因焦虑而受到干扰。B组：在测试的200个肩部中，26个肩部（17例患者）在麻醉状态下测试为阳性（13%）。5个在未麻醉时前冲试验为阳性。C组：在测试的200个肩部中，5个肩部前冲试验为阳性（2.5%）。在麻醉状态下，该测试的敏感性为100%，特异性为87%，阳性预测值为55%，阴性预测值为100%。未麻醉时，该测试的敏感性为31%，特异性为97.5%，阳性预测值为66%，阴性预测值为90%。
前冲试验显示的不稳定与肱骨头在关节盂前缘前方的前半脱位有关。它以最小的幅度再现了患者所认可的临床不稳定。对于慢性前不稳定，该测试在麻醉状态下总是阳性，它可以在手术开始前确认术前诊断，并指导手术方式的选择。焦虑是前冲检测的主要障碍，但对于肩部前不稳定的其他经典临床测试也是如此。
因此，肩部前冲试验是一种能够确诊前不稳定的测试。未来将能够证实其有效性，并确认该测试是否可以通过外展变化区分前不稳定和下不稳定，正如本初步研究所显示的那样。
