Spesifik Omuz Muayene Testlerinin Klinik Etkinliğinin Araştırılması

Omuz şikayetleri genel popülasyonda üçüncü sıklıkta karşılaşılan kas iskelet sistemi problemlerindendir. Omuz patolojilerini ortaya koymak için fizik muayene manevraları oldukça fazladır. Bu manevraların geçerlilikleri halen net olarak ortaya konamamıştır. Bu çalışmada ki amaç, pratikte kullanılan spesifik omuz fizik muayene testlerinin klinik doğruluğu açısından manyetik rezonans görüntüleme ile arasındaki uyum ve/veya uyumsuzluğu ortaya koymaktır. Omuz ağrısı ile polikliniğe başvuran hastalar sırasıyla çalışmaya dahil edildi. Kriterlere uyan 47 hastanın, 28’ i kadın (%59.6), 19’ u erkek (%40.4) idi. Hastaların ortalama yaşı 59.5514.11 (yaş aralığı: 21-82) idi. Etkilenen omuzların 30’ u (%63.8) sağ, 17’ si (%36.2) sol taraftı. Hastaların 39’ nun (%83) dominant ekstremitesi sağ taraf, sekiz’nin (%17) dominant ekstremitesi ise sol taraftı. Çalışmaya dahil edilen hastaların 27’ sinin (%57.4) omuz MRG’ si dış merkezde çekilmişken, 20’ nin (%42.6) MRG’ si de merkezimizde çekilmişti. Omuz fizik muayene testleri ortopedik cerrah tarafından gerçekleştirildi. Muayenede omuz sıkışma testleri, rotator kaf testleri, labral testler, instabilite testleri, biseps tendon testleri ve akromioklaviküler eklem değerlendirme testleri gerçekleştirildi. Hastaların manyetik rezonans görüntüleme tetkikleri referans standart olarak alındı. Spesifik testlerin özgüllük ve duyarlılıkları çapraz tablo yapılarak hesaplandı ve manyetik rezonans görüntüleme ile olan uyumu ortaya kondu. Tüm spesifik omuz testlerinin ve MRG deki anatomik yapıların patolojileri karşılaştırıldığında istatistiksel olarak anlamlı çıkan değerler makalede tablo içinde belirtilmiştir. Çalışmamızda spesifik omuz muayene testlerinin MRG ile korelasyonu çeşitli farklılıklar gösterse de genelde literatürle uyumlu bulunmuştur. Bu testlerin geçerlilikleri ileride yapılacak daha çok merkezli ve geniş kapsamlı çalışmalarla ortaya konmalıdır.

Anahtar Kelimeler:

Manyetik rezonans görüntüleme, Omuz, Fizik muayene, Teşhis, Teşhis doğruluğu

Shoulder complaints are the most third musculoskeletal problems in general population. There are many physical exam maneuvers to manifest the shoulder problems. The aim of this study is to show the correlation and/or discorrelation of clinical accuracy of specific shoulder physical exam tests, which are using in practice, with magnetic resonance imaging. The patients who have admitted to outpatient clinic with shoulder pain were included respectively to this study. Of 47 patients who are fit to criteria, there were 28 female (59.6 %) and 19 male (40.4 %). The mean age was 59.5514.11 (age between: 21-82). There were 30 (63.8 %) right and 17 (36.2%) left affected shoulder. The dominant extremity were right in 39 (83%) and were left side in 8 (17%) patients. While the shoulder MRI of 27 (57.4%) of the patients included in the study was taken in the outer center, 20 (42.6%) MRI was also taken in our center. Shoulder physical exam tests were performed by one orthopaedic surgeon. Shoulder impingement tests, rotator cuff tests, labral tests, instability tests, biceps tendon tests and acromioclavicular joint evaluation tests were examined during the physical exam. The magnetic resonance imaging of patients were taken as a reference standard. The sensitivity and specificity of specific tests were calculated by cross table and the correlation of the tests were shown with magnetic resonance imaging method. The statistically significant values, which were compared between spesific shoulder tests and the patologic anatomic structures on magnetic resonance imaging, were mentioned as a table in the manuscript. However the correlation of specific shoulder physical exams with MRI shows different results in our study, it was shown compatible results with literature generally. The validity of these tests should be cleared out in the future with multiple centered and large extended studies.

Keywords:

Magnetic resonance imaging; Shoulder; Physical examination; Diagnosis; Diagnostic accuracy,

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