Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions.
Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions.
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DOI：
10.1055/s-0037-1606829
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发表时间：
2017-10
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影响因子：
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通讯作者：
Bryant D
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作者：
Somerville LE;Willits K;Johnson AM;Litchfield R;LeBel ME;Moro J;Bryant D
目的 由于病因众多且多种疾病同时存在的可能性，肩部疼痛和残疾给诊断带来了挑战。支持对上盂唇前后复合体（SLAP）进行临床测试的证据很弱或不存在。本研究的目的是通过进行方法严格、临床适用的研究来确定 SLAP 病变体检操作的诊断有效性。 方法 我们连续招募了报告疼痛和/或残疾的新肩部患者。医生记录了病史并表明了他们对每种可能诊断的确定性（“确定诊断不存在/存在”或“不确定需要进一步测试”）。临床医生对仍存在不确定性的诊断进行了身体测试。磁共振成像关节造影和关节镜检查是金标准。我们计算了敏感性、特异性和似然比 (LR)，并研究了顶级测试的组合是否提供了更强的预测。 结果 93 名患者接受了 SLAP 病变的体检。当使用 SLAP 病变（I-V 型）作为疾病阳性时，所有测试均不敏感（10.3-33.3），尽管它们具有中等特异性（61.3-92.6）。当疾病阳性被定义为已修复的 SLAP 病变（包括二头肌肌腱固定术或肌腱切开术）时，测试的敏感性 (10.5–38.7) 和特异性 (70.6–93.8) 有所提高，尽管幅度不大。没有发现任何测试在临床上可用于预测所有 LR 接近 1 的可修复 SLAP 损伤。对于两种疾病定义，压缩旋转测试具有最佳 LR（SLAP 撕裂存在 = 1.8 和 SLAP 修复 = 1.67）。诊断可修复 SLAP 损伤没有最佳的测试组合，至少两项测试呈阳性可提供最佳的测量特性组合（敏感性 46.1%，特异性 64.7%）。 结论 我们的研究表明，SLAP 病变的体格检查不能作为疾病的诊断指标。执行组合测试可能会有所帮助，尽管改进的幅度很小。这些作者告诫临床医生要对 SLAP 病变的体格检查充满信心，而不是建议临床医生依靠诊断成像来确认这一诊断。
Purpose Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study. Methods We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis (“certain the diagnosis is absent/present,” or “uncertain requires further testing”). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions. Results Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I–V) as disease positive, none of the tests was sensitive (10.3–33.3) although they were moderately specific (61.3–92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5–38.7) and specificity (70.6–93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and specificity 64.7%). Conclusion Our study demonstrates that the physical examination tests for SLAP lesions are poor diagnostic indicators of disease. Performing a combination of tests will likely help, although the magnitude of the improvement is minimal. These authors caution clinicians placing confidence in the physical examination tests for SLAP lesions rather we suggest that clinicians rely on diagnostic imaging to confirm this diagnosis.