Correlação do exame físico com achados artroscópicos no tratamento da ruptura do manguito rotador

Resumo

Objetivo Comparar dados clínicos do exame físico com os achados artroscópicos na ruptura do manguito rotador.

Métodos Foram selecionados 177 pacientes submetidos ao tratamento artroscópico de ruptura do manguito rotador e foram comparados os achados artroscópicos com o exame físico.

Resultados Os testes irritativos de impacto apresentaram alta sensibilidade para ruptura do manguito rotador. Dentre os testes de força, o de maior sensibilidade foi o teste de Patte (85,7%) e o de maior valor preditivo positivo (VPP) foi o teste de Jobe (95%). O teste Drop Sign apresentou maior especificidade e valor preditivo negativo (VPN) (98,7 e 95,9%, respectivamente). Pacientes com história de trauma possuíam 3,5 vezes mais chances de apresentarem o teste Lift Off positivo.

Conclusão Os testes irritativos tiveram alta sensibilidade para rupturas do manguito rotador. O teste de Jobe apresentou sensibilidade semelhante entre os pacientes que tinham lesão parcial ou total do supraespinhal. Para as lesões completas do subescapular, as testes Lift Off e Belly Press apresentaram alta sensibilidade e especificidade.

Palavras-chave

artroscopia - exame físico - manguito rotador - ombro - ruptura

• Referências

• 1 Neer 2nd. CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972; 54 (01) 41-50
• 2 Malhi AM, Khan R. Correlation between clinical diagnosis and arthroscopic findings of the shoulder. Postgrad Med J 2005; 81 (960) 657-659
• 3 Pompan DC. Appropriate use of MRI for evaluating common musculoskeletal conditions. Am Fam Physician 2011; 83 (08) 883-884
• 4 Jobe FW, Jobe CM. Painful athletic injuries of the shoulder. Clin Orthop Relat Res 1983; (173) 117-124
• 5 Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle. Clinical features in 16 cases. J Bone Joint Surg Br 1991; 73 (03) 389-394
• 6 Hertel R, Ballmer FT, Lombert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 1996; 5 (04) 307-313
• 7 Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower's’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br 1998; 80 (04) 624-628
• 8 Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 1996; 78 (07) 1015-1023
• 9 Debeyre J, Elmelik E, Patte D. [Shoulder injuries and ruptures of the musculo-tendinous cuff]. Presse Med 1963; 71: 1521-1522
• 10 Neer 2nd. CS. Impingement lesions. Clin Orthop Relat Res 1983; (173) 70-77
• 11 Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980; 8 (03) 151-158
• 12 Yocum LA. Assessing the shoulder. History, physical examination, differential diagnosis, and special tests used. Clin Sports Med 1983; 2 (02) 281-289
• 13 Yergason RM. Supination sing. J Bone Joint Surg Am 1931; 13 (01) 160-161
• 14 Bennett WF. Specificity of the Speed's test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy 1998; 14 (08) 789-796
• 15 Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?. J Bone Joint Surg Am 2005; 87 (06) 1229-1240
• 16 Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 2007; 89 (06) 1184-1193
• 17 Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 1990; (254) 64-74
• 18 MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg 2000; 9 (04) 299-301
• 19 Nicoletti SJ, Albertoni WM. Valor do exame físico no diagnóstico do pinçamento subacromial e das lesões do manguito rotador. Rev Bras Ortop 1993; 28 (09) 679-682
• 20 Leroux JL, Thomas E, Bonnel F, Blotman F. Diagnostic value of clinical tests for shoulder impingement syndrome. Rev Rhum Engl Ed 1995; 62 (06) 423-428
• 21 Fowler EM, Horsley IG, Rolf CG. Clinical and arthroscopic findings in recreationally active patients. Sports Med Arthrosc Rehabil Ther Technol 2010; 2: 2
• 22 Bartsch M, Greiner S, Haas NP, Scheibel M. Diagnostic values of clinical tests for subscapularis lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18 (12) 1712-1717
• 23 Schiefer M, Ching-San Júnior YA, Silva SM. et al. Clinical diagnosis of subscapularis tendon tear using the Bear Hug semiological maneuver. Rev Bras Ortop 2012; 47 (05) 588-592
• 24 Cardoso A, Amaro P, Barbosa L, Coelho AM, Alonso R, Pires L. Diagnostic accuracy of clinical tests directed to the long head of biceps tendon in a surgical population: a combination of old and new tests. J Shoulder Elbow Surg 2019; 28 (12) 2272-2278