Особливості розташування лопатки у пацієнтів із болями в ділянці плеча: достовірність досліджень та важливість клінічних тестів

Next, the measurement of the distance from the medial scapular border to the fourth thoracic spinous processes (fig 2) was performed as described by Host. 3 The test was performed with the patient standing and instructed to stay relaxed. Both the fourth thoracic spinous process and the medial scapular border were identified through palpation. The distance betweenboth anatomic landmarks was measured in the horizontal plane using a tape measure. Again, this procedure was repeated with the patient actively retracting both shoulders. To achieve active bilateral shoulder retraction, the patient was instructed to actively move both shoulders backward.

The LSST was designed by Kibler9 to assess scapular asymmetry under varying loads. To maintain a consistent posture during the various test positions, subjects were instructed to fix their eyes on an object in the examination area. « For the first test position of the LSST, the patient was instructed to keep the arms relaxed at his/her sides. When the test position was obtained and confirmed by the assessor, the most inferior aspect of the inferior angle of the scapula and the closest spinous process in the same horizontal plane were identified through palpation and marked. The distance between the 2 reference points was measured bilaterally with a tape measure. This procedure was repeated for test position 2 (the patient was instructed to actively place both hands on the ipsilateral hips, and consequently the humerus was positioned in medial rotation at ±45° of abduction in the coronal plane) and test position 3 (the patient was instructed to actively extend both elbows and to elevate and maximally internally rotate [«thumbs down»] both arms at or below 90° in the coronal plane). Test positions 2 and 3 are illustrated in figures 3 and 4, respectively. Between test positions 2 and 3, the patient was instructed to reposition the upper extremities from the test position to neutral.

Statistical Analysis. All data were analyzed using SPSS, version 11. 0, a for Windows. Appropriate descriptive statistics were used (mean, standard deviation [SD], standard error of the mean, and range for age, illness duration, VAS scores, SDQ scores, and the outcome on the 3 clinical tests; frequencies and percentage for gender and symptomatic side). For examining the interobserver reliability of the clinical tests, the ICC (2-way mixed-effect model) was used. 2122 For interpretation of the ICCs, we used the threshold value of. 70 to define fair reliability. 17 The Cronbach a coefficient was computed to examine the internal consistency of the outcome of the clinical tests. For examining the clinical importance of the outcome of the clinical tests, we used 2 different statistical approaches. First, we used a Pearson correlation analysis for examining the associations between the self-reported measures and the tests' outcomes. Second, we compared the outcomes of the clinical tests between the symptomatic and asymptomatic side using a paired-samples Student; test. A 1-sample Kolmogorov-Smirnov goodness-of-fit test was used to examine whether the variables entering a Student t test and Pearson correlation analysis were normally distributed. The significance level was set at. 01 to help protect against potential type I errors.

 

 

Twenty-nine patients with shoulder pain were recruited; 19 subjects were women (65. 5%), and in 18 patients (62. 1%) the right shoulder was affected. The mean age of the study sample was 56. 6±14. 9 years (range,. 18±81y), and the mean shoulder pain duration was 13. 7±27. 1 months. The mean SDQ total scores ranged between 13% and 100% disability (mean total score ± SD, 58. 3% ±20. 1%), and the mean VAS pain score was 11. 3± 16. 3mm (range, 4±62mm). The descriptive statistics of the outcome of the first assessor on the 3 clinical tests are presented in table 1, and for assessor 2 these data are presented in table 2.

 

Table 1:

Descriptive Statistics of the Outcome on the 3 Clinical Tests for the Assessment of Scapular Positioning: Symptomatic

TestnMean ± SD (mm) SEMRange (mm) MP*) 

Acromion

Table relaxed-symptomatic side2971, 9±15, 22, 945-107-, 11 (, 32) 

Table relaxed-asymptomatic side2972, 3 + 12, 52, 355-104

Table retraction-symptomatic side2946, 0±20, 53, 920-103-1, 02 (, 91) 

Table retraction-asymptomatic side2947, 9+20, 13, 823-100

Scapula

T4 relaxed-symptomatic side2958, 2±14, 62, 720-90, 43 (67) 

T4 relaxed-asymptomatic side2958, 2±14, 92, 819-93

T4 retraction-symptomatic side2931, 2±13, 42, 58-681, 82 (, 08) 

T4 retraction-asymptomatic side2929, 3+9, 91, 910-53

LSST

Position 1-symptomatic side2989, 7±21, 74, 255-1621, 11