Klinik Subakromial Sıkışma Testi Pozitif Hastaların Ultrasonografik Subakromial Sıkışma Testi ile Değerlendirilmesi

Yıl 2024, Cilt: 6 Sayı: 3, 289 - 296, 14.10.2024

Yasemin Tombak , Özgür Zeliha Karaahmet

https://doi.org/10.52827/hititmedj.1402370

Öz

Amaç: Subakromial sıkışma sendromunda kullanılan özel klinik testlerin tanıdaki başarısının bilinmesi hasta değerlendirmesinde, ileri tetkik gerekip gerekmemesi ve tedavi düzenlenmesi açısından önemlidir. Bu gözle, subakromial sıkışma sendromu tanılı hastalarda sonografik olarak sıkışma varlığını referans alarak klinik muayene testlerinin tanısal performansını belirlemek amaçlandı.
Gereç ve yöntemler: Çalışmaya Fizik Tedavi ve Rehabilitasyon polikliniğine şikâyeti omuz ağrısı olan ve muayenede en az 1 subakromial sıkışma testi pozitif olan (Neer, Hawkins veya Yocum testinden en az biri) 42 hasta dahil edildi.
Omuza abdüksiyon yaptırarak korakoakromial alanda supraspinatus tendonuna ait dinamik sonografik sıkışma bulgusu değerlendirildi. Klinik muayene testleri ile dinamik sonografik sıkışma bulgusu karşılaştırıldı.
Bulgular: Hastaların % 40,5’inde ultrasonografik olarak sıkışma testi pozitif idi. Hawkins testi %81 hastada, Neer testi %69 hastada, Yocum testi %78,6 hastada pozitif idi. Ultrasonografik olarak değerlendirilen subakromial sıkışma testi ile Neer testi arasında anlamlı ilişki saptandı, diğer özel testler (Hawkins ve Yocum testi) ile anlamlı ilişki saptanmadı (p=0,02, p=0,4, p=0,12 sırasıyla).
Sonuç: Ultrasonografik dinamik subakromial sıkışma bulgusunun, non-invaziv ve cihaz bağımsız yapılabilen fizik muayene testlerinden Neer testi ile anlamlı ilişkisini göstermiş olduk.

Anahtar Kelimeler

Dinamik sonografik sıkışma, Hawkins testi, Neer testi, omuz ağrısı, subakromial sıkışma sendromu, Yocum testi

Evaluation of Clinical Subacromial Impingement Test Positive Patients with Ultrasonographic Subacromial Impingement Test

Öz

Objective: Knowing which of the special clinical tests used in subacromial impingement syndrome is more successful in making the diagnosis is important for patient evaluation, determining if further examination is necessary, and arranging treatment. Utilizing sonographic impingement as a reference diagnostic technique, the study sought to evaluate how well clinical test results performed in diagnosing patients with subacromial impingement syndrome.
Material and method: The study involved 42 patients with shoulder pain and at least one positive subacromial impingement test, including Neer, Hawkins, or Yocum tests. Dynamic sonographic compression of the tendon in the coracoacromial area was examined by abducting the shoulder. Dynamic sonographic compression findings were compared with clinical examination tests.
Results: In 40.5% of the patients, the ultrasonographic impingement test was positive. Hawkins test was positive in 81% of patients, Neer test was positive in 69% of patients, and Yocum test was positive in 78.6% of patients. A significant relationship was found between the ultrasonographically evaluated subacromial impingement test and the Neer test, but no significant relationship was found with other special tests (Hawkins and Yocum test) (p = 0.02, p = 0.4, p = 0.12, respectively).
Conclusion: We have demonstrated a significant relationship between the ultrasonographic finding of dynamic subacromial impingement and the Neer test, which is a non-invasive and device-independent physical examination test.

Anahtar Kelimeler

Dynamic sonographic impingement, Hawkins test, Neer test, shoulder pain, subacromial impingement syndrome, Yocum test

Etik Beyan

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflict of interest.

Destekleyen Kurum

None

Teşekkür

The Authors thank Osman Ertan (MD, at Physical Medicine and Rehabilitation, Ankara Etlik City Hospital, Ankara, Turkey) for participation in illustrations of the application of the tests subject of this article.

Kaynakça

• Urwin M, Symmons D, Allison T, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998; 57: 649-655.
• Habermeyer P. Schulterchirurgie. Fourth edition. München: Elsevier, Urban & Fischer. 2010.
• Rothenberg A, Gasbarro G, Chlebeck J, Lin A. The Coracoacromial Ligament: Anatomy, Function, and Clinical Significance. Orthop J Sports Med. 2017; 5: 2325967117703398.
• Mackenzie TA, Herrington L, Horlsey I, Cools A. An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it? Clinical biomechanics 2015; 30: 641–648.
• Khan Y, Nagy MT, Malal J, Waseem M. The painful shoulder: shoulder impingement syndrome. The open orthopaedics journal 2013; 7: 347–351.
• Gismervik SØ, Drogset JO, Granviken F, Rø M, Leivseth G. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord. 2017; 18: 41.
• Chang KV, Wu WT, Ozcakar L. Association of Bicipital Peritendinous Effusion with Subacromial Impingement: A Dynamic Ultrasonographic Study of 337 Shoulders. Sci Rep. 2016; 6: 38943.
• Calis M, Akgun K, Birtane M, Karacan I, Calis H, Tuzun F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000; 59: 44-47.
• Beaudreuil J, Nizard R, Thomas T, et al. Contribution of clinical tests to the diagnosis of rotator cuff disease: a systematic literature review. Joint Bone Spine. 2009;76(1):15-19.
• Silva L, Andreu JL, Munoz P, et al. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford), 2008;47(5): 679-683.
• Neer CS. Anterior acromioplasty for chronic impingement syndrome of shoulder. J Bone Joint Surg Am 1972; 54: 41–50.
• Neer CS. Impingement lesions. Clin Orthop 1983; 173: 70–77.
• Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980; 8: 151–158.
• Yocum LA. Assessing the shoulder. History, physical examination, differential diagnosis, and special tests used. Clin Sports Med 1983; 2: 281–289.
• Bureau NJ, Beauchamp M, Cardinal E, Brassard P. Dynamic sonography evaluation of shoulder impingement syndrome. Am J Roentgenol 2006; 187: 216–220.
• Farin PU, Jaroma H, Harju A. Shoulder impingement syndrome: sonographic evaluation. Radiology. 1990; 176: 845-849.
• Daghir AA, Sookur PA, Shah S. Dynamic ultrasound of the subacromial-subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers. Skeletal Radiol. 2012; 41: 1047-1053.
• Webber H. Ultrasound of the shoulder in impingement syndrome [abstract]. The 20th Annual Scientific Meeting of the Australasian Society for Ultrasound in Medicine; September 1990; Adelaide, Australia
• Wang YC, Wang HK, Chen WS, Wang TG. Dynamic visualization of the coracoacromial ligament by ultrasound. J Ultrasound Med Biol 2009; 35: 1242–1248.
• Magee DJ. Shoulder. In: Orthopedic Physical Assessment. Philadelphia: WB Saunders Company, 1992: 90–142.
• Warren RF. Shoulder pain. In: Paget S, Pellicci P, Beary JF, eds. Manuel of Rheumatology and outpatientorthopaedic disorders. Boston: Little, Brown, 1993: 99–109
• Somerville LE, Willits K, Johnson AM, et al. Clinical Assessment of Physical Examination Maneuvers for Rotator Cuff Lesions. Am J Sports Med. 2014; 42: 1911-1919.
• 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: 299-301.
• Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009; 90: 1898-1903.
• Sengul M, Karagoz A, Nacir B, Erdem HR. Omuz Agrili Hastalarda Klinik Testlerin Tanisal Performanslarinin Arastirilmasi. Turk Fiz Tip Rehab Derg 2014; 60: 236-244.
• Fodor D, Poanta L, Felea I, Rednic S, Bolosiu H. Shoulder impingement syndrome: correlations between clinical tests and ultrasonographic findings. Ortop Traumatol Rehabil. 2009; 11: 120-126.
• Awerbuch MS. The clinical utility of ultrasonography for rotator cuff disease, shoulder impingement syndrome and subacromial bursitis. MJA 2008; 188: 50–53.
• Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Heath Technology Assessment 2003; 7: 1–185.
• Read JW, Perko M. Ultrasound diagnosis of subacromial impingement for lesions of the rotator cuff. Australas J Ultrasound Med. 2010; 13: 11-15.