初診時における肩腱板断裂と五十肩の身体所見
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<B>Background:</B> We need to diagnose the rotator cuff tears and shoulder adhesive capsulitis at the first examination. The purpose of this study was to clarify the difference of physical findings between rotator cuff tears and shoulder adhesive capsulitis.<BR><B>Methods:</B> 247 patients were examined and diagnosed as having rotator cuff tears or shoulder adhesive capsulitis on MRI. The rotator cuff tears group consisted of 157 patients with 88 males and 69 females. The adhesive capsulitis group consisted 90 patients with 50 males and 40 females. Muscle atrophy, tenderness on palpation, delle on the greater tuberosity, shoulder active ROM (flexion, extension, abduction, external rotation and internal rotation), terminal pain, limitation of passive shoulder motion, shoulder strength, impingement sign, belly press test, and lift off test were examined and compared between the two groups.<BR><B>Results:</B> The average age of the rotator cuff tear group was 68 years and that of the adhesive capsulitis group was 59 years. The incidence of several findings showed the statistical differences between the two groups. The strength of abduction at 45 degrees, the strength of abduction at 90 degrees, the strength of external rotation, painful arc sign, delle on the greater tuberosity, atrophy of infraspinatus and the tenderness on palpation of the greater tuberosity were high in the Odds ratio. Shoulder ROM in adhesive capsulitis was statistically less than that in rotator cuff tears.<BR><B>Conclusion:</B> The weakness of shoulder abduction and external rotation would suggest rotator cuff tear. Especially, the loss of 45 degrees abduction strength was the physical finding for rotator cuff tear that had the highest accuracy. In addition, normal shoulder strength and the limitation of shoulder ROM would suggest adhesive capsulitis.
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