| Objective:(1)This study intends to evaluate the clinical value of shoulder physical examination in the diagnosis of supraspinatus tendon tear,and to explore the diagnostic value of different physical examination and combined application.(2)This study intends to evaluate the value of high field 3.0T MRI in the diagnosis of supraspinatus tendon tear,and to compare the results of partial and complete supraspinatus tendon tear with those of shoulder arthroscopy,and then to evaluate its diagnostic value.Objects and methods:Patients with shoulder diseases who underwent arthroscopic shoulder surgery in Yueyang No.2 People’s Hospital from January 2019 to January2021 were collected.5 patients with previous shoulder surgery,2 patients with incomplete MRI data and 1 patient who could not cooperate with physical examination were excluded.Among them,71 patients were traumatic injury and 57 patients were non-traumatic injury.All patients underwent standard physical examination of shoulder jo int before operation.8 physical examinations including subacromial tend erness,shoulder,Hawkins sign,Neer sign,shrug sign,Jobe sign,arm drop test,pain arc,0~o abduction impedance test and 3.0T high field MR I were performed,and then shoulder arthroscopy was performed,taking microscopic diagnosis as the gold standard of diagnosis.The sensitivity,specificity and Youden index of 8 physical examinations were calculated,and the individual physical examination with the highest diagnostic value was selected according to the level of Youden index after the definite diagnosis.The individual physical examination was sorted according to the Youden index,and the physical examination with the highest Youden index was selected for the joint diagnostic experiment to evaluate the clinical value of the combined diagnostic test.For the evaluation of the diagnostic value of Kappa,the results of partial and complete supraspinatus tendon tears were compared with the final diagnosis under shoulder arthroscopy,and the consistency of MRI and shoulder arthroscopy was compared by MRI test in addition to evaluating the results of all patients with supraspinatus tendon tear and non-supraspinatus tendon tear.Results:3.0T nuclear magnetic resonance examination have the highest sensitivity and specificity,which is 91.14%and 93.87%respectively compared with physical examination and the Youden index is 0.85.Among them,the sensitivity of MRI is 80%,the specificity is 96.30%,and the Youden index is 0.76 in the diagnosis of partial tear of supraspinatus tendon;the sensitivity of MRI is 96.30%,the specificity is 84%,and the Youden index is 0.8 in the diagnosis of complete tear of supraspinatus tendon.The diagnostic value of MRI and arthroscopy in partial and complete tear of supraspinatus muscle is highly consistent with that of shoulder arthroscopy(Kappa=0.815).Among the 8 physical examinations,the highest sensitivity of pain arc is81.01%,and the examination with highest specificity is falling arm test,which is 89.79%.Moreover,the examination with highest highest Youden index is Jobe sign,which is 0.42,and the examination with lowest Youden index is Hawkins sign,which is 0.11.Jobe’s sign,0~o abduction resistance test and falling arm test have the highest specificity in series test,which is 100%in the joint diagnostic test.In other words,all the patients with positive physical examination have supraspinatus tendon tear and there was no misdiagnosis.Jobe’s sign,0~oabduction impedance test,falling arm test and Neer sign have the highest sensitivity in parallel experiments,which is 100%.In other words,at least one of the above four physical examinations is positive and there was no missed diagnosis in all patients with supraspinatus tendon tears in this study.Conclusion:(1)Physical examination has certain practical value in the diagnosis of supraspinatus tendon tear,especially the combined diagnostic test have unique value in the clinical diagnosis and screening of supraspinatus tendon tear,three of which can be used for clinical diagnosis and four of which can be used for screening.(2)3.0T MRI in the diagnosis of supraspinatus tendon tear is highly consistent with the results of shoulder arthroscopy,and have equal value in the diagnosis of partial tear and complete tear. |
