Clinical Study Of Comprehensive Diagnostic System In Diagnosising Rotator Cuff Tear

ObjectiveTo analyze the diagnostic value of various examination methods such as clinical symptoms,special physical examination,X-ray and MRI imaging for rotator cuff tear,in order to establish a comprehensive diagnostic system to help identify rotator cuff tear.MethodsThis study retrospectively analyzed 133 patients who underwent the arthroscopic shoudler surgeon in the Department of Orthopedics of Guangdong Provincial Hospital of Traditional Chinese Medicine(The second Clinical Medical College affiliated by Guangzhou University of Chinese Medicine)from January 2017 to December 2018.The combined observation of the posterior and external approach of the arthroscopic shoulder was the gold standard,and the diagnostic value of various examination methods such as clinical symptoms,special physical examination,X-ray and MRI imaging for rotator cuff tear was analyzed and evaluated.ResultsA total of 133 patients were enrolled in the study.103 patients with rotator cuff tears(RCT)including partial thickness(PT)tears and full thickness(FT)tears were diagnosed on the basis of the gold standard examination,and 30 patients with complete rotator cuff were included.There were 42 cases of FT supraspinatus tears,56 cases of PT supraspinatus tears;15 cases of FT infraspinatus tears and 5 cases of PT infraspinatus tears;7 cases of FT subscapularis tears and 20 cases of PT subscapular tears.The Youden index of the three symptoms of limitation of ROM,weak strength,and special type of pain is greater than 0,which has diagnostic value.The accuracy of limitation of ROM is 77.4%,and weak strength Youden index is just 0.285.The sensitivity of the two positive diagnostic protocols in the three symptoms was 82.5%.The positive rate of 9 special physical examinations was significantly different in patients with RCT and intact rotator cuffs.When at least 2 positives occurred in 5 tests including Jobe test,drop-arm test,external rotation resistance test,Lift off test,Napoleon test,and meantime at least 2 positives occurred in 4 tests including Neer sign,Hawkins sign,pain arc test,and tenderness,which is regard as RCT.The accuracy rate of the physical examination combination was 90.2%.AH(AUC=0.62,cut-off point 9.8mm),AI(AUC=0.77,cut-off point 0.69),CSA(AUC=0.63,cut-off point 38.5°),and AGA(AUC=0.65,cut-off point 52.0°)all can be used as a diagnostic criteria for RCT.The Youden index of MRI diagnosis of RCT was 0.616,and the accuracy rate was 85.0%.The former had a minimum accuracy of 74.4%.There was no significant difference in the diagnostic rate between physical examination and MRI,but the Youden index of the physical examination combination was higher at 0.780.ConclusionA joint observation approach with the posterior approach and the external approach for exploration can accurately and clearly observe the specific circumstances of the rotator cuff tear,so that the microscopic diagnosis can be the gold standard.The three symptoms of limitation of ROM,weak strength,and special type of pain,as well as their combined diagnostic scheme,have diagnostic value.Nine special physical examinations have diagnostic value,and the diagnostic value of the combined diagnostic scheme is higher than that of MRI,which is worthy of promotion.X-ray measurement of AH,AI,CSA,AGA have diagnostic value,of which AI is more diagnostic,can be used as an auxiliary diagnostic method for rotator cuff tear.