| Summary: | 碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 98 === Background: Shoulder impingement is the most common disorder of the shoulder. It can be categorized into the primary, secondary and internal types of impingement. Many screening tests have been developed to aid for diagnosing shoulder impingement; however, the validity of the single test is not satisfactory. Because accurate diagnosis and proper management is based on accuracy of the screening tests, there is a need to improve validity of the tests for different types of shoulder impingement. Purposes: To establish validity of the screening tests for different types of shoulder impingement syndrome and to explore if combing different tests could result in better test validity as compared to single tests. Methods: This was an exploratory cross-sectional study design. Sixty subjects with possible shoulder impingement syndrome (38 males, 22 females) were recruited. We performed 15 shoulder impingement screening tests after the subjects filled out basic information and pain history. The subjects were grouped into a primary, secondary or internal impingement type based on physician’s clinical examination combined with imaging findings or by imaging diagnosis alone. Descriptive analyses were used to summarize subjects’ basic information such as age, height, weight, gender, physical activity, and pain history. We computed sensitivity, specificity, overall accuracy and positive likelihood ratio for the 15 clinical tests with the two-by-two table method. We used the Chi squared tests to compare test results between those with or without primary impingement and those with external or internal impingement. We also used a cross-matching method to form combination tests that could best discriminate among the three types of shoulder impingement syndrome. Statistical significance level (P) was set at 0.05. Results: According to the physician’s diagnosis, the painful arc test had the best diagnostic accuracy of 73% in the primary impingement type; the sulcus sign gave the best diagnostic accuracy of 93% in the secondary type; and the internal rotation resistance test yielded the best accuracy of 90% in the internal impingement type. When combining the painful arc, Neer’s, impingement relief, and the supraspinatus tests, with 2 of the 4 tests being positive, the screening accuracy would improve to 78% for the primary impingement syndrome as diagnosed by the physician. When combining the the Neer’s, Speed, Sulcus sign, apprehension-relocation, and load and shift tests, with 4 of the 5 tests being positive, the screening accuracy would improve to 97% for secondary impingement syndrome as diagnosed by the physician. When all three of the supraspinatus, apprehension-relocation and internal rotation resistance tests were positive, the screening accuracy improved to 98% for internal impingement as diagnosed by the physician. The screening validity was slightly lower in both the single and combination tests when the diagnosis was made by the imaging data alone. Conclusions: Combining different tests would yield better accuracy than the single tests in differentiating different types of shoulder impingement syndromes. The screening validity was better for diagnoses made by the physician than by imaging data alone.
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