本日は、肩痛について。
Chronic shoulder pain: part I. Evaluation and diagnosis.
History Findings and Associated Shoulder Disorders
HISTORY | ASSOCIATED CONDITION | |||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
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Selected Tests of the Shoulder
EXAMINATION MANEUVER | ASSOCIATED CONDITION | SENSITIVITY (%) | SPECIFICITY (%) | LR+ | LR− |
---|---|---|---|---|---|
Inspection |
|||||
Supraspinatus or infraspinatus atrophy10 |
Chronic rotator cuff tear |
56 |
73 |
2.07 |
0.60 |
Palpation |
|||||
Acromioclavicular tenderness16 |
Acromioclavicular joint OA or chronic sprain |
96 |
10 |
1.07 |
0.4 |
Range of motion |
|||||
Restrictive active10 |
Rotator cuff disorder |
30 |
78 |
1.36 |
0.90 |
Provocative tests |
|||||
Hawkins' impingement15 |
Impingement/rotator cuff disorder |
72 |
66 |
2.1 |
0.42 |
Large rotator cuff tear |
27 |
88 |
2.25 |
0.83 |
|
Empty-can supraspinatus15 |
Rotator cuff disorder involving supraspinatus |
44 |
90 |
4.4 |
0.62 |
Lift-off subscapularis17 |
Rotator cuff disorder involving subscapularis |
62 |
100 |
> 25 |
0.38 |
External rotation/infraspinatus strength15 |
Rotator cuff disorder involving infraspinatus |
42 |
90 |
4.2 |
0.64 |
Cross-body adduction18 |
Acromioclavicular joint OA or chronic sprain |
77 |
79 |
3.50 |
0.29 |
Apprehension19 |
Glenohumeral instability |
72 |
96 |
20.22 |
0.29 |
Relocation19 |
Glenohumeral instability |
81 |
92 |
10.35 |
0.2 |
LR+ = positive likelihood ratio; LR- = negative likelihood ratio; OA = osteoarthritis.
note: The recommended progression of shoulder examination maneuvers is inspection, palpation, range of motion and strength tests, and provocative tests.
Figures 1a and 1b.
Hawkins' Impingement Test. Forward flex the arm to 90 degrees with the elbow bent to 90 degrees. The arm is then internally rotated. A positive test, noted by pain on internal rotation, may signify subacromial impingement including rotator cuff tendinopathy or tear.
ドロップアーム回旋腱板テスト~Large rotator cuff tear、感度27%、特異度88%、LR+2.25、LR-0.83
Imaging Tests for Rotator Cuff Tears
IMAGING TEST | FINDING | SENSITIVITY (%) | SPECIFICITY (%) | LR+ | LR− |
---|---|---|---|---|---|
Any rotator cuff tear |
83 |
86 |
4.85 |
0.22 |
|
Partial thickness rotator cuff tear |
44 |
90 |
3.99 |
0.66 |
|
Full thickness rotator cuff tear |
89 |
93 |
10.63 |
0.16 |
|
Ultrasonography |
Any rotator cuff tear |
80 |
85 |
5.09 |
0.27 |
Partial thickness rotator cuff tear |
67 |
94 |
8.90 |
0.36 |
|
Full thickness rotator cuff tear |
97 |
96 |
13.16 |
0.16 |