Ure B M, Tiling T, Kirchner R, Rixen D
II. Lehrstuhl für Chirurgie, Universität Köln.
Unfallchirurg. 1993 Jul;96(7):382-6.
The results of clinical shoulder examination including 20 special tests were compared with subsequent arthroscopic findings in 45 patients. The sensitivity of the clinical diagnosis was 73%. Impingement syndrome was correctly diagnosed in 19 of 22 cases (86%), rotator cuff tears in 7 of 9 cases (78%). The highest sensitivity for stage II impingement was found for the supraspinatus test (85%) and the lift-up test (92%); the sensitivity of these tests for rotator cuff tears was 100% and 89% respectively. Differentiation between impingement syndrome with and without rotator cuff tear by one of these tests alone was not possible because of their low positive predictive values (26% and 56%). In contrast, in 90% of patients with negative rotator tests the rotator cuff was complete, while the negative predictive value of the supraspinatus test was 100%. Instability was confirmed in only 53% of cases; the Leffert test had the highest positive predictive value (73%). In conclusion, the clinical diagnosis of a shoulder lesion cannot reliably be achieved by single tests; rather overall evaluation by an experienced clinician is necessary.
对45例患者的临床肩部检查结果（包括20项特殊检查）与随后的关节镜检查结果进行了比较。临床诊断的敏感性为73%。22例中有19例（86%）正确诊断为撞击综合征，9例中有7例（78%）诊断为肩袖撕裂。对于Ⅱ期撞击，冈上肌试验（85%）和举升试验（92%）的敏感性最高；这些试验对肩袖撕裂的敏感性分别为100%和89%。由于其阳性预测值较低（26%和56%），仅通过这些试验之一无法区分有无肩袖撕裂的撞击综合征。相比之下，在90%的旋转试验阴性患者中，肩袖是完整的，而冈上肌试验的阴性预测值为100%。仅53%的病例证实存在不稳定；Leffert试验的阳性预测值最高（73%）。总之，肩部病变的临床诊断不能通过单一试验可靠地实现；相反，需要由经验丰富的临床医生进行全面评估。
