肩甲下筋腱損傷に対する徒手検査の診断精度

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  • Diagnostic accuracy of clinical tests for subscapularis lesions

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Background: Subscapularis (SSC) lesions are often underdiagnosed in clinical routine. The purpose of this study is to examine the diagnostic values of clinical tests for SSC lesions.<BR>Methods: 26 consecutive patients, including 18 men and 14 women with a mean age of 59.6 years old who underwent arthroscopic procedures for rotator cuff lesions, were clinically evaluated using the belly-press test (BPT), the bear-hug test (BHT) and the lift-off test (LOT) preoperatively. Diagnostic arthroscopy was the reference that determined the actual pathologic lesions. For the three tests, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each test were calculated. Diagnostic accuracy was determined using positive likelihood ratios (LR).<BR>Results: SSC tears occurred with a prevalence of 61.5%. The BPT was found to be the most sensitive (60.0%) of all (BHT; 55.6%, LFT; 33.3%). The specificity was 76.3% for the BPT, 74.5% for the BHT and 75.0% for the LOT respectively. All of those showed a positive likelihood ratio less than 5 (BPT; 3.05, BHT; 2.21, LOT; 1.21), suggesting that they were inaccurate independently of each other. Combinations of three tests increased positive LR and PPV (all tests were positive; positive LR and PPV were 6.86 and 88.4%, both BPT and BHT were positive; positive LR and PPV were 5.32 and 85.1%), suggesting they were considered to be diagnostically useful.<BR>Conclusion: Three clinical tests for SSC lesion were singularly inaccurate. However, the combination of those tests can lead to improved diagnostic accuracy for SSC lesions.

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  • 肩関節

    肩関節 37 (2), 795-798, 2013

    日本肩関節学会

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