ABSTRACT
Limited evidence exists regarding the validity of clinical examination for the detection of shoulder pathology. We therefore wished to establish the sensitivity, specificity, positive predictive value and negative predictive value of clinical tests and magnetic resonance imaging (MRI) in the diagnosis of rotator cuff disorders against findings at arthroscopy. Using recognised tests for specific shoulder lesions, 117 patients with shoulder symptoms awaiting surgery were examined in a standard manner. The diagnoses were categorised and compared with abnormalities found on MRI and at surgery. Results were cross-tabulated to determine the above parameters. Ninety-four patients formed the study group with a mean age of 51 years. The median duration of symptoms was 45 weeks. For clinical examination, sensitivity and specificity to detect a tear or rupture of supraspinatus were 30 % (16/54) and 38 % (15/40) and, for the detection of any pathology, were 94 % (67/71) and 22 % (5/23), respectively, compared with arthroscopy. Correspondingly, the sensitivity of MRI compared with arthroscopy to detect a tear or rupture of supraspinatus was 90 % (28/31) with a specificity of 70 % (46/53), whereas for the detection of any abnormality, the sensitivity was 92 % (65/71) with a specificity of 48 % (11/23). The sensitivity of detecting any rotator cuff abnormality is high when examination and MRI is compared with arthroscopy with the specificity being greater with MRI than examination. In patients with shoulder symptoms severe enough to consider surgery, clinical assessment followed by specific imaging may help define the pathology in order to direct appropriate management.
Subject(s)
Arthroscopy/methods , Magnetic Resonance Imaging/methods , Rotator Cuff Injuries , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Physical Examination/methods , Predictive Value of Tests , Reference Standards , Reproducibility of Results , Sensitivity and Specificity , Shoulder/pathology , Shoulder Injuries , Shoulder Joint/pathology , Tendinopathy/diagnosis , Tendinopathy/pathology , Young AdultABSTRACT
Hamstring injuries have a high incidence and recurrence rate. Much is understood with regards to the mechanism of hamstring injury, with eccentric loading at fast rates being important. Little is known about the aetiology of hamstring injury, with age and previous injury being the only causative factors with robust scientific support. Clinically, it can be difficult to differentiate between a lesion occurring in hamstring tissue and pain that is experienced in the hamstrings that is referred from elsewhere. The use of specific examination procedures such as the slump test and the straight leg raise, supplemented with other sensitive and specific tests can help in the differential diagnosis. This chapter will explore the aetiology of chronic hamstring injury/posterior thigh pain, will discuss the differential diagnosis of chronic hamstring/posterior thigh pain, and present a model for the management of these injuries.
Subject(s)
Muscle, Skeletal/injuries , Pain Management , Pain/diagnosis , Thigh , Chronic Disease , Humans , Pain/etiology , Wounds and Injuries/diagnosis , Wounds and Injuries/etiology , Wounds and Injuries/therapyABSTRACT
Local injection therapies, used in the management of a variety of musculoskeletal pain syndromes, include the local infiltration of substances such as corticosteroid, anaesthetic, sclerosants and botulinum toxin, as well as dry needling alone and neural blockade. In this chapter, a number of injection therapies for soft-tissue-mediated pain are described. The reasoning for their use, potential mechanisms of action and unwanted effects are discussed. The literature relating to their effects is critically reviewed. Practical suggestions for their utilisation in the management of soft-tissue conditions are given and proposals are made for future research in this important area.
