Metric properties of provocative manual tests for shoulder impingement syndrome – literature review

Uvod: Bolečina v ramenskem sklepu je zelo pogost simptom mišično-kostnih poškodb in bolezni ter ima velik vpliv na zmanjšano zmožnost funkcioniranja posameznika v družbi. Eden od možnih vzrokov je utesnitveni sindrom ramenskega sklepa. Za učinkovito zdravljenje je potrebna natančna diagnoza, ki jo dobimo s telesnim pregledom, ki je temelj vsakega procesa zdravljenja. V klinični praksi se pogosto uporabljajo manualni testi, vendar njihova diagnostična vrednost ni povsem jasno dokazana. Merske lastnosti testov nam povedo, kako natančni so pri ugotavljanju okvar in ali so klinično uporabni. Namen: Namen diplomskega dela je na podlagi pregleda literature predstaviti občutljivost, specifičnost, pozitivno in negativno razmerje verjetnosti manualnih testov za določanje utesnitvenega sindroma ramenskega sklepa in okvar, ki so povezane z njim, ter določiti, ali so diagnostično natančni in uporabni v kliničnem okolju. Metode dela: Literatura je bila pridobljena preko podatkovnih baz PubMED, PEDro in The Cochrane Library. Iskanje je bilo omejeno na angleški in slovenski jezik ter na objave od leta 2004 naprej. Rezultati: Kriterijem je ustrezalo 19 člankov, objavljenih med letoma 2004 in 2019. Od teh so v sedmih obravnavali utesnitveni sindrom, v šestih okvare kit mišic rotatorne manšete, diskinezijo lopatice v štirih raziskavah, nestabilnost ramenskega sklepa v dveh in okvaro kite dolge glave mišice biceps brachii v devetih. Rezultati so pokazali nizko diagnostično natančnost manualnih testov za ugotavljanje utesnitvenega sindroma ramenskega sklepa in okvar, povezanih z njim. Test polne pločevinke in test oklevanja sta lahko uporabna v kliničnem okolju, test mišice biceps brachii z obremenitvijo II in O\u27Brienov test imata zmerno močne dokaze za diagnostično uporabo v praksi. Razprava in sklep: Samostojen manualni test nima diagnostične vrednosti, kombinacije dveh ali več pa lahko povečajo njihovo diagnostično natančnost. Med diagnostičnimi raziskavami obstaja velika heterogenost glede zlatega standarda, vzorcev, tarčnih okvar, poimenovanj testov in posledično metodološke kvalitete. Zaradi tega obstajajo različni in pogosto nasprotujoči si rezultati glede diagnostičnih vrednosti provokativnih manualnih testov. Ovira pri analizi merskih lastnosti je pomanjkanje standardiziranih protokolov izvedbe testov. Treba je raziskati, katere kombinacije testov dajejo najbolj diagnostično natančne rezultate za določeno okvaro, saj raziskave kažejo, da na podlagi enega provokativnega manualnega testa ne moremo sklepati o vzroku okvare. Nujno je oblikovanje algoritma za prepoznavanje utesnitvenega sindroma ramenskega sklepa s provokativnimi manualnimi testi ter poenotenje definicije utesnitvenega sindroma ramena, kar bo omogočilo primerjavo izsledkov raziskav. V premislek je treba vzeti, ali lahko z manualnimi testi neko strukturo v telesu z določenim položajem ali gibom izolirano testiramo neodvisno od drugih funkcijsko in anatomsko povezanih struktur.Background: Shoulder pain is very often a symptome of muscle - bone injuries and dysfunction and has a big influence on decreased function of individual in society. One of the possible causes is impingement syndrome of the shoulder. To treat effectively an accurate diagnosis is essential, which can be acquired with physical examination, as it is a corner stone of treatment. Manual tests are often used in clinical milieu, but their diagnostic value remains to be proven by research. Metric properties show accuracy of a test in diagnosing a pathology and its usefulness in clinical milieu. Purpose: The purpose of this dissertation is to present sensibility, specifity and positive and negative likelihood ratio of manual tests, whose aim is to detect impingement syndrome of shoulder and related dysfunctions and to decide their diagnostic accuracy and usefulness in clinical milieu. Methods: Literature review was obtained through PubMED, PEDro, The Cochrane Library. Search was limited to English and Slovene publications issued after 2004. Results: The criteria were met by 19 publications, between 2004 and 2019. In seven of them analyzed impingement syndrome of shoulder, in six of them tendons of muscles of rotator cuff, in four of them scapular dyskinesis, in two instability of the shoulder and in nine examined tendon of the long head of biceps brachii. Results have shown low diagnostic accuracy of manual tests for diagnosing impingement syndrome of shoulder and pathologies connected to impingement syndrome of shoulder. Full can test and apprehension test can be useful in clinical milieu, biceps load II test and O\u27Briens test have moderate evidence for clinical use. Discussion and conclusion: One provocative manual test does not have sufficient diagnostic value, combination of two or more can increase their diagnostic accuracy. Amid diagnostic studies there is heterogeneity of gold standard, samples, target pathology, names of tests and consecvently methodical quality. Because of that there are different and often contrary results of diagnostic accuracy of provocative manual tests. Disadvantage in analysing diagnostic characteristics is absence of protocols for manual tests. More research is needed to find which combinations of tests give the best diagnosticaly meaningfull results for specific pathology, because research shows, that one provocative manual test cannot give information of cause of pathology. It is essential to form an algorithm for detecting impingement syndrome of shoulder with provocative manual tests and to uniform a definition of impingement of shoulder, which will enable comparisson of different diagnostic studies. It has to be taken in reconsideration if manual tests can test one structure independently of other functional and anatomicaly connected structures