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The Evidenced-Based Shoulder Evaluation

机译：循证肩膀评估

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The physical examination of the shoulder has been studied extensively, but the quality and statistical power of the published research often is lacking. The initial reports of new shoulder examination techniques commonly describe impressive performance. However recent meta-analyses have found that when the majority of these tests are used in isolation, they lack the ability to rule in or rule out the pathology in question, with few exceptions. The diagnostic accuracy of the physical examination improves when the shoulder tests are evaluated in combination, such as positive passive distraction and active compression identifying a superior labral anterior to posterior (SLAP) lesion. The accuracy also can be improved when the shoulder tests are evaluated in conjunction with specific historical findings, such as age greater than 39 years, history of popping or clicking, and a positive painful arc (pain experienced between 60 degrees and 120 degrees of abduction) identifying rotator cuff tendinopathy. The literature on shoulder imaging demonstrates that rotator cuff tears can be ruled in or ruled out by both ultrasound and magnetic resonance imaging. For SLAP lesions, magnetic resonance arthrography can be used to rule out a tear but may not be as accurate as combined physical examinations to rule in a tear.
机译：肩部的身体检查已被广泛研究，但通常缺乏已发表研究的质量和统计能力。新的肩部检查技术的初步报告通常描述令人印象深刻的性能。但是，最近的荟萃分析发现，当这些测试中的大多数单独使用时，它们几乎没有能力排除或排除所讨论的病理。结合肩部检查评估身体检查的诊断准确性，例如，积极的被动牵张和主动压迫可以识别出上唇后前方（SLAP）病变。当结合特定的历史发现（例如，年龄大于39岁，弹出或卡嗒的历史以及正痛的弧度（外展60度至120度之间的疼痛））对肩部测试进行评估时，也可以提高准确性。确定肩袖肌腱病。关于肩部成像的文献表明，超声和磁共振成像均可排除或排除肩袖撕裂。对于SLAP病变，可以使用磁共振关节造影排除泪液，但可能不如联合物理检查准确以排除泪液。

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