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Spesifik Omuz Muayene Testlerinin Klinik Etkinliğinin Araştırılması

Yıl 2020, , 670 - 681, 09.11.2020

Cüneyd Günay

https://doi.org/10.20515/otd.776588
Cited By: 2

Öz

Omuz şikayetleri genel popülasyonda üçüncü sıklıkta karşılaşılan kas iskelet sistemi problemlerindendir. Omuz patolojilerini ortaya koymak için fizik muayene manevraları oldukça fazladır. Bu manevraların geçerlilikleri halen net olarak ortaya konamamıştır. Bu çalışmada ki amaç, pratikte kullanılan spesifik omuz fizik muayene testlerinin klinik doğruluğu açısından manyetik rezonans görüntüleme ile arasındaki uyum ve/veya uyumsuzluğu ortaya koymaktır. Omuz ağrısı ile polikliniğe başvuran hastalar sırasıyla çalışmaya dahil edildi. Kriterlere uyan 47 hastanın, 28’ i kadın (%59.6), 19’ u erkek (%40.4) idi. Hastaların ortalama yaşı 59.5514.11 (yaş aralığı: 21-82) idi. Etkilenen omuzların 30’ u (%63.8) sağ, 17’ si (%36.2) sol taraftı. Hastaların 39’ nun (%83) dominant ekstremitesi sağ taraf, sekiz’nin (%17) dominant ekstremitesi ise sol taraftı. Çalışmaya dahil edilen hastaların 27’ sinin (%57.4) omuz MRG’ si dış merkezde çekilmişken, 20’ nin (%42.6) MRG’ si de merkezimizde çekilmişti. Omuz fizik muayene testleri ortopedik cerrah tarafından gerçekleştirildi. Muayenede omuz sıkışma testleri, rotator kaf testleri, labral testler, instabilite testleri, biseps tendon testleri ve akromioklaviküler eklem değerlendirme testleri gerçekleştirildi. Hastaların manyetik rezonans görüntüleme tetkikleri referans standart olarak alındı. Spesifik testlerin özgüllük ve duyarlılıkları çapraz tablo yapılarak hesaplandı ve manyetik rezonans görüntüleme ile olan uyumu ortaya kondu. Tüm spesifik omuz testlerinin ve MRG deki anatomik yapıların patolojileri karşılaştırıldığında istatistiksel olarak anlamlı çıkan değerler makalede tablo içinde belirtilmiştir. Çalışmamızda spesifik omuz muayene testlerinin MRG ile korelasyonu çeşitli farklılıklar gösterse de genelde literatürle uyumlu bulunmuştur. Bu testlerin geçerlilikleri ileride yapılacak daha çok merkezli ve geniş kapsamlı çalışmalarla ortaya konmalıdır.

Anahtar Kelimeler

Manyetik rezonans görüntüleme Omuz Fizik muayene Teşhis Teşhis doğruluğu

Kaynakça

  • 1. Stevenson JH, Trojian T: Evaluation of shoulder pain. J Fam Pract 2002;51(7):605–11.
  • 2. Sharma G, Bhandary S, Khandige G, Kabra U. MR Imaging of Rotator Cuff Tears: Correlation with Arthroscopy. J Clin Diagn Res. 2017;11(5):TC24-TC27.
  • 3. Gyftopoulos S, O' Donnell J, Shah NP, Goss J, Babb J, Recht MP. Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience. Skeletal Radiol. 2013;42(9):1269-75.
  • 4. Magee DJ (2014), Orthopedic physical assessment, 6th ed. Philadelphia: Saunders.
  • 5. Pandey T, Slaughter AJ, Reynolds KA, Jambhekar K, David RM, Hasan SA. Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy. Radiographics. 2014;34(2):e24-40.
  • 6. Neer CS II. Impingement lesions. Clin Orthop Relat Res 1983;173:70-7.
  • 7. Hawkins RJ, Kennedy JC. Impingement syndromes in athletes. Am J Sports Med. 1980;8:151-8.
  • 8. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610-13.
  • 9. McFarland EG, Torpey BM, Curl LA. Evaluation of shoulder laxity. Sports Med 1996;22:264-72.
  • 10. Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg. 2011;20(4):537-42.
  • 11. Somerville LE, Willits K, Johnson AM, Litchfield R, LeBel ME, Moro J, Bryant D. Clinical Assessment of Physical Examination Maneuvers for Rotator Cuff Lesions. Am J Sports Med. 2014;42(8):1911-9.
  • 12. Caliş Birtane M, M, Akgün K. The diagnostic value of magnetic resonance imaging in subacromial impingement syndrome. Yonsei Med J. 2001;42(4): 418–24.
  • 13. MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg. 2000;9(4):299-301.
  • 14. Pandya NK, Colton A, Webner D, Sennett B, Huffman GR. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy. 2008;24(3):311-7.
  • 15. Somerville L, Bryant D, Willits K, Johnson A. Protocol for determining the diagnostic validity of physical examination maneuvers for shoulder pathology. BMC Musculoskelet Disord. 2013;14:60.
  • 16. Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR: Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elbow Surg. 2006,15(5):580–85.
  • 17. Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. AJR Am J Roentgenol. 2006;187(6):1448–52. 
  • 18. Hayes ML, Collins MS, Morgan JA, Wenger DE, Dahm DL. Efficacy of diagnostic magnetic resonance imaging for articular cartilage lesions of the glenohumeral joint in patients with instability. Skeletal Radiol. 2010;39(12):1199–204. 
  • 19. Toyoda H, Ito Y, Tomo H, Nakao Y, Koike T, Takaoka K: Evaluation of rotator cuff tears with magnetic resonance arthrography. Clin Orthop Relat Res. 2005;439:109–15.
  • 20. van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Terwee CB, Willems WJ. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability. J Shoulder Elbow Surg. 2013;22(10):1310-9.
  • 21. Loh B, Lim JB, Tan AH. Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging? Ann Transl Med. 2016;4(21):419.
  • 22. Fiorella D, Helms CA, Speer KP. Increased T2 signal intensity in the distal clavicle: incidence and clinical implications. Skeletal Radiol. 2000;29(12):697-702.
  • 23. Jordan LK, Kenter K, Griffiths HL. Relationship between MRI and clinical findings in the acromioclavicular joint. Skeletal Radiol. 2002;31(9):516-21.
  • 24. Jain NB, Fan R, Higgins LD, Kuhn JE, Ayers GD. Does My Patient With Shoulder Pain Have a Rotator Cuff Tear?: A Predictive Model From the ROW Cohort. Orthop J Sports Med. 2018;6(7):2325967118784897.
  • 25. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009;192(6):1701–7. 
  • 26. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;24:9.
  • 27. Barth J, Audebert S, Toussaint B, et al. Diagnosis of subscapularis tendon tears: are available diagnostic tests pertinent for a positive diagnosis? Orthop Traumatol Surg Res. 2012;98(suppl 8):S178-S185.
  • 28. Yuen CK, Mok KL, Kan PG. The validity of 9 physical tests forfull-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients. Am J Emerg Med. 2012;30(8):1522-29.
  • 29. Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996;78(7):1015-23.
  • 30. Aagaard KE, Hänninen J, Abu-Zidan FM, Lunsjö K. Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears: a prospective study. Eur J Trauma Emerg Surg. 2018;44(5):735-45.
  • 31. Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010;26(11):1427-33.
  • 32. Bhandari M, Montori VM, Swiontkowski MF, Guyatt GH. User’s guide to the surgical literature: how to use an article about a diagnostic test. J Bone Joint Surg Am 2003;85:1133-40.

Yıl 2020, , 670 - 681, 09.11.2020

Cüneyd Günay

https://doi.org/10.20515/otd.776588
Cited By: 2

Öz

Shoulder complaints are the most third musculoskeletal problems in general population. There are many physical exam maneuvers to manifest the shoulder problems. The aim of this study is to show the correlation and/or discorrelation of clinical accuracy of specific shoulder physical exam tests, which are using in practice, with magnetic resonance imaging. The patients who have admitted to outpatient clinic with shoulder pain were included respectively to this study. Of 47 patients who are fit to criteria, there were 28 female (59.6 %) and 19 male (40.4 %). The mean age was 59.5514.11 (age between: 21-82). There were 30 (63.8 %) right and 17 (36.2%) left affected shoulder. The dominant extremity were right in 39 (83%) and were left side in 8 (17%) patients. While the shoulder MRI of 27 (57.4%) of the patients included in the study was taken in the outer center, 20 (42.6%) MRI was also taken in our center. Shoulder physical exam tests were performed by one orthopaedic surgeon. Shoulder impingement tests, rotator cuff tests, labral tests, instability tests, biceps tendon tests and acromioclavicular joint evaluation tests were examined during the physical exam. The magnetic resonance imaging of patients were taken as a reference standard. The sensitivity and specificity of specific tests were calculated by cross table and the correlation of the tests were shown with magnetic resonance imaging method. The statistically significant values, which were compared between spesific shoulder tests and the patologic anatomic structures on magnetic resonance imaging, were mentioned as a table in the manuscript. However the correlation of specific shoulder physical exams with MRI shows different results in our study, it was shown compatible results with literature generally. The validity of these tests should be cleared out in the future with multiple centered and large extended studies.

Anahtar Kelimeler

Magnetic resonance imaging; Shoulder; Physical examination; Diagnosis; Diagnostic accuracy

Kaynakça

  • 1. Stevenson JH, Trojian T: Evaluation of shoulder pain. J Fam Pract 2002;51(7):605–11.
  • 2. Sharma G, Bhandary S, Khandige G, Kabra U. MR Imaging of Rotator Cuff Tears: Correlation with Arthroscopy. J Clin Diagn Res. 2017;11(5):TC24-TC27.
  • 3. Gyftopoulos S, O' Donnell J, Shah NP, Goss J, Babb J, Recht MP. Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience. Skeletal Radiol. 2013;42(9):1269-75.
  • 4. Magee DJ (2014), Orthopedic physical assessment, 6th ed. Philadelphia: Saunders.
  • 5. Pandey T, Slaughter AJ, Reynolds KA, Jambhekar K, David RM, Hasan SA. Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy. Radiographics. 2014;34(2):e24-40.
  • 6. Neer CS II. Impingement lesions. Clin Orthop Relat Res 1983;173:70-7.
  • 7. Hawkins RJ, Kennedy JC. Impingement syndromes in athletes. Am J Sports Med. 1980;8:151-8.
  • 8. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610-13.
  • 9. McFarland EG, Torpey BM, Curl LA. Evaluation of shoulder laxity. Sports Med 1996;22:264-72.
  • 10. Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg. 2011;20(4):537-42.
  • 11. Somerville LE, Willits K, Johnson AM, Litchfield R, LeBel ME, Moro J, Bryant D. Clinical Assessment of Physical Examination Maneuvers for Rotator Cuff Lesions. Am J Sports Med. 2014;42(8):1911-9.
  • 12. Caliş Birtane M, M, Akgün K. The diagnostic value of magnetic resonance imaging in subacromial impingement syndrome. Yonsei Med J. 2001;42(4): 418–24.
  • 13. MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg. 2000;9(4):299-301.
  • 14. Pandya NK, Colton A, Webner D, Sennett B, Huffman GR. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy. 2008;24(3):311-7.
  • 15. Somerville L, Bryant D, Willits K, Johnson A. Protocol for determining the diagnostic validity of physical examination maneuvers for shoulder pathology. BMC Musculoskelet Disord. 2013;14:60.
  • 16. Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR: Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elbow Surg. 2006,15(5):580–85.
  • 17. Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. AJR Am J Roentgenol. 2006;187(6):1448–52. 
  • 18. Hayes ML, Collins MS, Morgan JA, Wenger DE, Dahm DL. Efficacy of diagnostic magnetic resonance imaging for articular cartilage lesions of the glenohumeral joint in patients with instability. Skeletal Radiol. 2010;39(12):1199–204. 
  • 19. Toyoda H, Ito Y, Tomo H, Nakao Y, Koike T, Takaoka K: Evaluation of rotator cuff tears with magnetic resonance arthrography. Clin Orthop Relat Res. 2005;439:109–15.
  • 20. van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Terwee CB, Willems WJ. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability. J Shoulder Elbow Surg. 2013;22(10):1310-9.
  • 21. Loh B, Lim JB, Tan AH. Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging? Ann Transl Med. 2016;4(21):419.
  • 22. Fiorella D, Helms CA, Speer KP. Increased T2 signal intensity in the distal clavicle: incidence and clinical implications. Skeletal Radiol. 2000;29(12):697-702.
  • 23. Jordan LK, Kenter K, Griffiths HL. Relationship between MRI and clinical findings in the acromioclavicular joint. Skeletal Radiol. 2002;31(9):516-21.
  • 24. Jain NB, Fan R, Higgins LD, Kuhn JE, Ayers GD. Does My Patient With Shoulder Pain Have a Rotator Cuff Tear?: A Predictive Model From the ROW Cohort. Orthop J Sports Med. 2018;6(7):2325967118784897.
  • 25. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009;192(6):1701–7. 
  • 26. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;24:9.
  • 27. Barth J, Audebert S, Toussaint B, et al. Diagnosis of subscapularis tendon tears: are available diagnostic tests pertinent for a positive diagnosis? Orthop Traumatol Surg Res. 2012;98(suppl 8):S178-S185.
  • 28. Yuen CK, Mok KL, Kan PG. The validity of 9 physical tests forfull-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients. Am J Emerg Med. 2012;30(8):1522-29.
  • 29. Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996;78(7):1015-23.
  • 30. Aagaard KE, Hänninen J, Abu-Zidan FM, Lunsjö K. Physical therapists as first-line diagnosticians for traumatic acute rotator cuff tears: a prospective study. Eur J Trauma Emerg Surg. 2018;44(5):735-45.
  • 31. Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010;26(11):1427-33.
  • 32. Bhandari M, Montori VM, Swiontkowski MF, Guyatt GH. User’s guide to the surgical literature: how to use an article about a diagnostic test. J Bone Joint Surg Am 2003;85:1133-40.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Cüneyd Günay 0000-0002-5050-3701

Yayımlanma Tarihi 9 Kasım 2020
Yayımlandığı Sayı Yıl 2020

Kaynak Göster

Vancouver Günay C. Spesifik Omuz Muayene Testlerinin Klinik Etkinliğinin Araştırılması. Osmangazi Tıp Dergisi. 2020;42(6):670-81.

Cited By

Subscapularis Tendon Tears: A Narrative Review
Archives of Current Medical Research
https://doi.org/10.47482/acmr.1413317
Is There A Relationship Between Critical Shoulder Angle and Fatty Degeneration and Number of Damaged Tendons in Rotator Cuff Arthropathy Patients?
OSMANGAZİ JOURNAL OF MEDICINE
Cüneyd GÜNAY
https://doi.org/10.20515/otd.998259


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