投球障害肩にみられる後方関節包拘縮に対する疼痛誘発テスト

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The purpose of this study was to investigate the efficacy of two new pain provocation tests to detect posterior capsular tightness seen in throwing shoulder injury. Fifty-eight shoulders with throwing shoulder injury were investigated. First, preoperatively the forced flexion internal rotation (FIR) test and the maximum abduction external rotation (ABER) test were performed as pain provocation tests. The FIR test was defined as positive, when the patient noted pain at the posterior or deep aspect of the shoulder on forced internal rotation at 90 degrees flexion of the shoulder, and the ABER test was defined as positive, when the patient noted pain at the posterior or deep aspect of the shoulder on forced external rotation at 90 degrees abduction of the shoulder. Second, posterior capsular tightness was evaluated on examination under general anesthesia and arthroscopy as a gold standard. The arthroscopic finding, which the posterior capsule and the posterior bundle of the inferior glenohumeral ligament were checked for their elasticity and presence of pathological fibrotic changes, was diagnostic criteria for posterior capsular tightness. Then, the efficacy of two tests was investigated. As results, posterior capsular tightness was positive in 46 shoulders, and was negative in 11. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FIR tests were 85%, 100%, 88%, 100%, and 61%, and those of ABER tests were 76%, 73%, 75%, 92%, and 42%, respectively. Furthermore, the results of those tests showed significant relationship with the presence of tightness. In conclusion, these two new tests were effective for the detection of posterior capsular tightness.
日本肩関節学会の論文
2008-06-30

投球障害肩にみられる後方関節包拘縮に対する疼痛誘発テスト

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