Klinische und apparative Untersuchungstechniken des Schultergelenks

Zusammenfassung

Die Diagnostik von Pathologien rund um das Schultergelenk ist komplex. Um die Diagnose einer Schulterläsion zu stellen bzw. deren Verlauf zu beurteilen, ist eine reproduzierbare klinische Befunderhebung essenziell. Dazu muss der Untersucher unter einer Vielzahl von Untersuchungstechniken auswählen. Der vorliegende Artikel soll ein Beispiel für einen standardisierten Untersuchungsgang mit nach wissenschaftlichen Gesichtspunkten ausgewählten Untersuchungstechniken bieten.

Diagnostic Procedures for the Shoulder Joint (Clinical and Instrumental)

The clinical evaluation of the shoulder joint is a challenging task. It is mandatory to evaluate the patientʼs history. The physical examination should consist of a defined portfolio of different tests that cover most pathologies. The article presents a standardised examination algorithm with a selected number of tests. The most common pathologies and the most suitable tests to detect them are presented in this article.

• Literatur

• 1 Murrell GA, Walton JR. Diagnosis of rotator cuff tears. Lancet 2001; 357: 769-770
• 2 Walton J et al. Diagnostic values of tests for acromioclavicular joint pain. J Bone Joint Surg Am 2004; 86-A: 807-812
• 3 Gerber C, Galantay RV, Hersche O. The pattern of pain produced by irritation of the acromioclavicular joint and the subacromial space. J Shoulder Elbow Surg 1998; 7: 352-355
• 4 Itoi E et al. Are pain location and physical examinations useful in locating a tear site of the rotator cuff?. Am J Sports Med 2006; 34: 256-264
• 5 Scheibel M, Habermeyer P. [Current procedures for clinical evaluation of the shoulder]. Orthopade 2005; 34: 267-283
• 6 Terwee CB et al. Interobserver reproducibility of the visual estimation of range of motion of the shoulder. Arch Phys Med Rehabil 2005; 86: 1356-1361
• 7 Kolber MJ et al. The reliability and concurrent validity of scapular plane shoulder elevation measurements using a digital inclinometer and goniometer. Physiother Theory Pract 2012; 28: 161-168
• 8 Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987; 214: 160-164
• 9 Lundberg BJ. The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand Suppl 1969; 119: 1-59
• 10 Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol 1975; 4: 193-196
• 11 Kirkley A, Griffin S, Dainty K. Scoring systems for the functional assessment of the shoulder. Arthroscopy 2003; 19: 1109-1120
• 12 Conboy VB et al. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br 1996; 78: 229-232
• 13 Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 2007; 16: 717-721
• 14 Michener LA et al. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil 2009; 90: 1898-1903
• 15 Fodor D et al. Shoulder impingement syndrome: correlations between clinical tests and ultrasonographic findings. Ortop Traumatol Rehabil 2009; 11: 120-126
• 16 Silva L et al. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford) 2008; 47: 679-683
• 17 Salaffi F et al. Clinical value of single versus composite provocative clinical tests in the assessment of painful shoulder. J Clin Rheumatol 2010; 16: 105-108
• 18 Park HB et al. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005; 87: 1446-1455
• 19 OʼBrien SJ et al. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 1998; 26: 610-613
• 20 Ebinger N et al. A new SLAP test: the supine flexion resistance test. Arthroscopy 2008; 24: 500-505
• 21 Fowler EM, Horsley IG, Rolf CG. Clinical and arthroscopic findings in recreationally active patients. Sports Med Arthrosc Rehabil Ther Technol 2010; 2: 2
• 22 Bencardino JT et al. Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder. Radiology 2000; 214: 267-271
• 23 Palmer WE, Brown JH, Rosenthal DI. Rotator cuff: evaluation with fat-suppressed MR arthrography. Radiology 1993; 188: 683-687
• 24 Gill HS et al. Physical examination for partial tears of the biceps tendon. Am J Sports Med 2007; 35: 1334-1340
• 25 Hegedus EJ et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med 2012; 46: 964-978
• 26 Zanetti M et al. Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol 1998; 170: 1557-1561
• 27 Hedtmann A. Weichteilerkrankungen der Schulter – Subakromialsyndrome. Orthopädie und Unfallchirurgie up2date 2009; 4: 85-103
• 28 Yamaguchi K et al. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 2006; 88: 1699-1704
• 29 Bartsch M et al. Diagnostic values of clinical tests for subscapularis lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18: 1712-1717
• 30 Scheibel M, Habermeyer P. Klinische Diagnostik von Rotatorenmanschettenläsionen. Arthroskopie 2007; 20: 6-12
• 31 Jobe FW, Moynes DR. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med 1982; 10: 336-339
• 32 Kim E et al. Interpreting positive signs of the supraspinatus test in screening for torn rotator cuff. Acta Med Okayama 2006; 60: 223-228
• 33 Hodler J et al. Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. Radiology 1992; 182: 431-436
• 34 Hedtmann A, Fett H. [Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff]. Orthopade 1995; 24: 498-508
• 35 Teefey SA et al. Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors. AJR Am J Roentgenol 2005; 184: 1768-1773
• 36 Dinnes J et al. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess 2003; 7: 1-166
• 37 Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 1991; 73: 389-394
• 38 Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 1996; 78: 1015-1023
• 39 Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy 2006; 22: 1076-1084
• 40 Scheibel M et al. The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy 2005; 21: 1229-1235
• 41 Greis PE et al. Validation of the lift-off test and analysis of subscapularis activity during maximal internal rotation. Am J Sports Med 1996; 24: 589-593
• 42 Kuechle DK et al. The relevance of the moment arm of shoulder muscles with respect to axial rotation of the glenohumeral joint in four positions. Clin Biomech (Bristol, Avon) 2000; 15: 322-329
• 43 Veeger HE et al. Inertia and muscle contraction parameters for musculoskeletal modelling of the shoulder mechanism. J Biomech 1991; 24: 615-629
• 44 Kim HA, Kim SH, Seo YI. Ultrasonographic findings of the shoulder in patients with rheumatoid arthritis and comparison with physical examination. J Korean Med Sci 2007; 22: 660-666
• 45 Castoldi F, Blonna D, Hertel R. External rotation lag sign revisited: accuracy for diagnosis of full thickness supraspinatus tear. J Shoulder Elbow Surg 2009; 18: 529-534
• 46 Walch G et al. The ‘dropping and ʼhornblowerʼs signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br 1998; 80: 624-628
• 47 Habermeyer P. Schulterchirurgie. 4.. Aufl. München: Urban & Fischer/Elsevier GmbH; 2010: 155-160
• 48 Rowe CR, Zarins B. Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am 1981; 63: 863-872
• 49 Gross ML, Distefano MC. Anterior release test. A new test for occult shoulder instability. Clin Orthop Relat Res 1997; 339: 105-108
• 50 Farber AJ et al. Clinical assessment of three common tests for traumatic anterior shoulder instability. J Bone Joint Surg Am 2006; 88: 1467-1474
• 51 Lo IK et al. An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability. Am J Sports Med 2004; 32: 301-307
• 52 Kim SH et al. Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. Am J Sports Med 2004; 32: 1849-1855
• 53 Liu SH et al. Diagnosis of glenoid labral tears. A comparison between magnetic resonance imaging and clinical examinations. Am J Sports Med 1996; 24: 149-154
• 54 Voigt C, Katthagen C, Lill H. Frakturen des Schultergürtels. Orthopädie und Unfallchirurgie up2date 2009; 4: 321-335