この患者さんは肩の不安定さ,あるいは腹筋の損傷がありますか?
Jolanda J Luime1, Arianne P Verhagen, Harald S Miedema
1The Netherlands Expert Centre for Work-related Musculoskeletal Disorders, Erasmus, University Medical Center Rotterdam, Rotterdam, The Netherlands. b.koes@erasmusmc.nl
JAMA
|October 28, 2004
まとめ
肩の不安定性の正確な診断は,移転と前部放出などの特定の臨床試験によって助けられます. しかし,関節内病理 (IAP) の診断にはさらなる調査が必要であり,バイセプス負荷IおよびIIテストが有望であることを示しています.
科学分野:
- 整形外科 整形外科 整形外科
- 診断の精度 診断の精度
- 肩のバイオメカニクス
背景:
- 肩の痛みの診断は,通常,病歴と臨床検査に基づいています.
- 肩の不安定性や関節内病理 (IAP) に対するこれらの方法の診断の正確性は不明である.
研究 の 目的:
- 肩の不安定性とIAPを特定するために,臨床試験と患者の病歴の診断精度を体系的に分析する.
主な方法:
- 複数のデータベース (PubMed,EMBASE,CINAHL) で包括的な文献検索が行われました.
- 対象となる研究では,病歴や身体検査の検査を基準基準と比較した.
- 診断精度研究の品質評価 (QUADAS) チェックリストを使用して,方法論的品質が評価されました.
主要な成果:
- リロケーションと前部放出テストは,肩の不安定性を診断する有用性を示しました (LRsは6.5から8.3まで).
- バイセプス負荷IとII,ミモリの痛み誘発,および内部回転抵抗力のテストは,腹部病変の診断に有望であることが示されました (LRsは7.2から29まで).
- 他のいくつかの一般的な検査は,あまり有用でないことが判明し, anamnesisやプライマリケア臨床試験の正確性に関する研究は確認されなかった.
結論:
- 転移と前部放出テストは,肩の不安定性を診断するための最良の証拠によってサポートされています.
- 腸内関節病理 (IAP) の診断の正確さは,特に腹部涙は,それほど明確ではありませんが,バイセプス負荷IとII,ミモリ疼痛誘発,および内部回転抵抗力のテストは最も有望です.
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