Pope D P, Croft P R, Pritchard C M, Macfarlane G J, Silman A J
ARC Epidemiology Research Unit, University of Manchester.
Br J Rheumatol. 1996 Nov;35(11):1137-41. doi: 10.1093/rheumatology/35.11.1137.
Prevalence studies suggest that shoulder pain is very common (7-20%) in the adult population, though little is known about the severity and impact of such pain. Disability results, in part, from the restriction of movement and we therefore determined the frequency of restricted shoulder movement in individuals in a general population sample reporting shoulder pain and associated disability. In all, 232 individuals were interviewed about shoulder pain and related disability, and their range of shoulder movement in the following planes was measured: elevation, forward flexion, backward flexion, external rotation and internal rotation, together with the minimum difference achieved between the tip of a thumb and the spinous process of C7. In total, 48 (21%) subjects reported current pain and disability in one or both shoulders. Using receiver operating characteristic (ROC) analysis, cut-offs for restricted movements were selected at the point of maximal discrimination between painful and pain-free shoulders. There was considerable overlap in the distribution of range of movement, at all six sites, between these two groups. The highest positive predictive value for pain was observed in restriction of the thumb to cervical spine movement (53%), but this also had the lowest negative predictive value. By contrast, the highest negative predictive value was observed for restriction of external rotation (96%). Restriction in any plane was observed in 77% of those individuals with pain, but was also present in half of those without pain. In summary, most people with self-reported shoulder pain in the community do not have widespread restriction of movement. Reduction in external rotation was the most discriminatory, but it is necessary to examine movement in multiple planes to assess the true burden of shoulder pain in the community.
患病率研究表明，肩痛在成年人群中非常普遍（7%-20%），不过对于这种疼痛的严重程度和影响却知之甚少。残疾部分是由活动受限导致的，因此我们确定了普通人群样本中报告有肩痛及相关残疾的个体中肩部活动受限的频率。总共对232名个体进行了关于肩痛及相关残疾的访谈，并测量了他们在以下平面的肩部活动范围：抬高、前屈、后屈、外旋和内旋，以及拇指尖与C7棘突之间达到的最小距离。总共有48名（21%）受试者报告一侧或双侧肩部目前存在疼痛和残疾。使用受试者工作特征（ROC）分析，在疼痛肩部和无痛肩部之间最大区分度的点上选择活动受限的临界值。这两组在所有六个部位的活动范围分布上有相当大的重叠。拇指至颈椎活动受限对疼痛的阳性预测值最高（53%），但阴性预测值最低。相比之下，外旋受限的阴性预测值最高（96%）。77%有疼痛的个体在任何平面都存在活动受限，但在无疼痛的个体中也有一半存在活动受限。总之，社区中大多数自我报告有肩痛的人并没有广泛的活动受限。外旋减少是最具区分性的，但有必要检查多个平面的活动以评估社区中肩痛的真实负担。
