Porównanie badania przedmiotowego i badania ultrasonograficznego u pacjentów z bólem stawu łopatkowo-ramiennego

• Authors: Raphael Micheroli , Diego Kyburz , Adrian Ciurea , Beat Dubs , Martin Toniolo , Samuel Pascal Bisig , Giorgio Tamborrini

Title variants

EN

Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder

• Languages of publication: EN PL

Abstracts

EN

Objective: High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the fi ndings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder. Methods: Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa. Results: In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86) whereas the Jobe supraspinatus test showed the highest specifi city (0.55). To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specifi city (0.72). The infraspinatus test showed a high sensitivity (0.90) and specifi city (0.74). All AC tests (painful arc IIa, AC joint tendernessb, cross body adduction stress testc) showed high specifi cities (a0.96, b0.99, c0.96). Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47) and the Yergason test the highest specifi city (0.88). Conclusion: Knowledge of sensitivity and specifi city of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.

PL

Cel badania: Ultrasonografia wysokiej rozdzielczości jest metodą niebolesną i nieinwazyjną. Jej duża przydatność w diagnostyce bólu stawu łopatkowo-ramiennego wynika z niedoskonałości badania przedmiotowego w ocenie tej patologii. Celem pracy było porównanie wyników badania przedmiotowego i ultrasonograficznego o wysokiej rozdzielczości, wykonywanych u pacjentów z bólem stawu łopatkowo-ramiennego. Materiał i metoda: Badanie obserwacyjne 100 dorosłych pacjentów z jednostronnym bólem stawu łopatkowo-ramiennego. Nie wykonywano procedur inwazyjnych. Kryteria wyłączenia: złamania w obrębie stawu łopatkowo-ramiennego, przebyte operacje stawu łopatkowo-ramiennego oraz iniekcje dostawowe w tym stawie w ciągu ostatniego miesiąca. Wykonujący standardowe badanie fizykalne stawu łopatkowo-ramiennego klinicyści nie mieli dostępu do wyników badań ultrasonograficznych a ultrasonografiści – do wyników badań fizykalnych. Wyniki: Test ciasnoty Hawkinsa i Kennedy’ego stosowany w diagnostyce patologii ścięgna mięśnia nadgrzebieniowego wykazał największą czułość (0,86), a test mięśnia nadgrzebieniowego Jobe’a największą swoistość (0,55). W ocenie zmian ścięgna mięśnia podłopatkowego test uniesienia kończyny od pośladka Gerbera wykazał czułość 1, podczas gdy test ucisku brzucha „belly press” odznaczył się wyższą swoistością (0,72). Oporowy test mięśnia podgrzebieniowego wykazał wysoką czułość (0,90) i swoistość (0,74). Wszystkie testy stosowane w patologiach stawu barkowo-obojczykowego (test bolesnego łukua, test uciskowy stawu barkowo-obojczykowegob, test skrzyżowanego przywodzeniac) cechowały się wysoką wrażliwością (a0,96, b0,99, c0,96). W przypadku patologii ścięgna głowy długiej mięśnia dwugłowego ramienia, test dłoni zwróconej ku górze wykazał najwyższą czułość (0,47), a test Yergasona najwyższą wrażliwość (0,88). Wnioski: Znajomość czułości i swoistości poszczególnych testów jest niezbędna do właściwej interpretacji badania fizykalnego stawu łopatkowo-ramiennego. Ultrasonografia o wysokiej rozdzielczości jest potrzebna do postawienia jednoznacznej diagnozy w większości przypadków.

Keywords

EN

badanie przedmiotowe; ból; diagnosis; diagnoza; pain; physical examination; shoulder; staw ramienny; ultrasonografia; ultrasonography

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Journal of Ultrasonography
• Year: 2015
• Volume: 15
• Issue: 60
• Pages: 29-44

Contributors

author

Raphael Micheroli

• Faculty of Medicine, University of Zurich, Switzerland

author

Diego Kyburz

• Department of Rheumatology, University Hospital of Basel, Switzerland

author

Adrian Ciurea

• Department of Rheumatology, University Hospital of Zurich, Switzerland

author

Beat Dubs

• Sonography Institute Glattpark, Zurich, Switzerland

author

Martin Toniolo

• Department of Rheumatology, University Hospital of Zurich, Switzerland

author

Samuel Pascal Bisig

• Swiss Federal Institute of Technology, Zurich, Switzerland

author

Giorgio Tamborrini

• Ultrasound Center, Department of Rheumatology, Bethesda Hospital Basel, Switzerland

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• Document Type: article