Stellenwert von Anamnese und klinischer Untersuchung beim degenerativen Impingement-Syndrom im Vergleich zu operativen Befunden - eine prospektive Studie

Abstract

50 patients with a degenerative shoulder-syndrome with impingement are evaluated by questioning and 17 clinical tests. Also taking in account findings of plain x-rays they are classified preoperatively as "rotator cuff tear" or "no tear". Only 4 of the maneuvers are positive in more than 66% of cases. Jobe test and Eppendorf test are especially useful in diagnosing an impingement syndrome. A painful are is found in only 48.9%. In the rupture group 9.7 maneuvers are positive while in the non rupture group it is 7.7 in the mean (not significant). Because no significant differences are noticed between groups for any of the tests a cuff tear can not be ruled out by a single sign. The overall rate of positive tests of both authors is similar (41.1%, 45.8%) but in detail differences are found in 21.2%. Useful (significant, p < 0.05) data for diagnosing a tear are older age (56.1 years vs. 47.7 years. in the non rupture group), previous (minor) trauma and radiological findings on plain films suggesting periarticular degenerative lesions. A calcifying tendinitis is consistent with pure impingement. The correct diagnosis confirmed by operation is made in 90% (sensitivity 91.3%, specificity 88.9%). This can be achieved only by an experienced clinician who takes into account all anamnestic and clinical findings, especially details that cannot be classified as just positive or negative and thus cannot be computerized.

Subacromial Impingement

“…13 Akgün et al observed 57.5% positive results with the test in stage 2 SIS patients. 11 For our patients whose average age was high, we observed more acromioclavicular joint degeneration and related pain reaction over 120 degrees of shoulder abduction.…”

“…10 13 PAINFUL ARC TEST Pain occurs between the angle of 60 and 120 degrees of shoulder abduction. 13 …”