全身麻酔下徒手検査による肩関節可動域と安定性評価の臨床的意義

概要

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Hypothesis: Range of motion and stability assessment in outpatient clinics are not usually true, comparative study with examination under anesthesia (EUA) is crucial for treatment of the shoulder. Methods: We investigated 188 shoulders from 2008 to 2010, including 59 female and 129 male. The average age was 50.7 ± 17.6 years old. EUA was performed with the patients in the beachchair position. Range of motion was estimated by goniometer and stability was rated as grade from 0 (normal) to 3 (dislocation). Results: Range of motion of the healthy shoulder and mobility (instability) decreases with aging. Females have a larger range of motion than males and dominant-side shoulder have a larger range of motion than non-dominant. Patients with anterior instability have a smaller range of internal and external rotation at 90 degrees abduction at outpatient clinic than EUA (14.5 ± 18.8 v/s 34.1 ± 12.8 degrees). Patients with cuff tear have a smaller range of internal rotation at 90 degrees abduction at outpatient clinic than EUA (7.6 ± 12.8 v/s 22.0 ± 17.1 degrees and 84.8 ± 16.3 v/s 98.6 ± 17.3 degrees, respectively). Discussion: These result suggest that apprehension and pain at particular positions of the arm induce a protective reaction and consequently reduce the range of motion at outpatient clinic. Comparative study with EUA is very crucial for treatment of the shoulder.