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Physical Examination Maneuvers for SLAP Lesions: A Systematic Review and Meta-analysis of Individual and Combinations of Maneuvers
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2022-08-23 , DOI: 10.1177/03635465221100977
Robert S Dean 1 , Leonard Onsen 2 , Jeniffer Lima 3 , Mark R Hutchinson 2
Affiliation  

Background:

Superior labrum anterior to posterior (SLAP) lesions are targeted on physical examination using a variety of provocative maneuvers.

Purpose/Hypothesis:

The purpose was to conduct a systematic review on the performance of physical examination maneuvers in diagnosing SLAP lesions and to perform a meta-analysis comparing the sensitivity and specificity of these examinations both individually and in combination. The null hypothesis stated that there would be no significant difference in the sensitivity or specificity of the included physical examination tests, neither individually nor in combination.

Study Design:

Meta-analysis and systematic review; Level of evidence, 4.

Methods:

A systematic review was performed with the inclusion criteria of studies that reported either the sensitivities and specificities or the number of true-positive, true-negative, false-positive, or false-negative results for at least 1 maneuver for identifying SLAP lesions. A meta-analysis was performed to determine the sensitivity and specificity of individual maneuvers. Additional analysis determined the performance of these maneuvers when combined in series and parallel. In series, all must be present to be considered positive. In parallel, any single positive test forces the overall combination to be considered positive. Only tests that were included in ≥3 studies were considered in the meta-analysis and those included in ≥4 studies were considered in the combination analysis.

Results:

Overall, 862 studies were identified, 18 of which were included in the systematic review and meta-analysis. The physical examinations included were the O’Brien (n = 16), speed (n = 8), Yergason (n = 6), anterior slide (n = 8), crank (n = 7), Jobe (n = 5), dynamic labral shear (n = 3), Kim 2 (n = 3), and biceps groove tenderness tests (n = 3). All combinations of 2 to 5 maneuvers in both series and parallel were considered. The O’Brien and crank test combination was the most sensitive 2-test combination in both parallel and series. The Yergason and anterior slide test combination was the most specific 2-test combination in parallel and series.

Conclusion:

This systematic review and meta-analysis reports an updated meta-analysis considering the sensitivity and specificity of common physical examination maneuvers used in the diagnosis of SLAP lesions and considers these values for tests in both series and parallel combinations. The present analysis demonstrates improved specificities when tests are considered in series and improved sensitivities when considered in parallel combination.



中文翻译:

SLAP 病变的体格检查动作:单个动作和组合动作的系统回顾和荟萃分析

背景:

使用各种激发操作对上盂唇前后 (SLAP) 病变进行体检。

目的/假设:

目的是对体格检查操作在诊断 SLAP 病变中的表现进行系统评价,并进行荟萃分析,比较这些检查单独和组合的敏感性和特异性。零假设指出,所包含的体检测试的敏感性或特异性不会有显着差异,无论是单独还是组合。

学习规划:

荟萃分析和系统评价;证据级别,4。

方法:

根据研究的纳入标准进行了系统评价,这些研究报告了至少 1 次识别 SLAP 病变的操作的敏感性和特异性或真阳性、真阴性、假阳性或假阴性结果的数量。进行荟萃分析以确定个体操作的敏感性和特异性。额外的分析确定了这些动作串联和并联组合时的性能。在系列中,所有的人都必须出现才能被认为是积极的。与此同时,任何单一的阳性测试都会迫使整个组合被认为是阳性的。荟萃分析中仅考虑 ≥3 项研究中包含的测试,组合分析中仅考虑 ≥4 项研究中包含的测试。

结果:

总体而言,共确定了 862 项研究,其中 18 项纳入了系统评价和荟萃分析。包括的体检包括 O'Brien (n = 16)、速度 (n = 8)、Yergason (n = 6)、前滑 (n = 8)、曲柄 (n = 7)、Jobe (n = 5) 、动态盂唇剪切 (n = 3)、Kim 2 (n = 3) 和二头肌沟压痛测试 (n = 3)。考虑了串联和并联 2 至 5 次机动的所有组合。奥布莱恩和曲柄测试组合是并联和串联中最灵敏的 2 测试组合。Yergason 和前滑动测试组合是并行和系列中最具体的 2 测试组合。

结论:

本系统回顾和荟萃分析报告了更新的荟萃分析,考虑了用于诊断 SLAP 病变的常见体检操作的敏感性和特异性,并考虑了串联和平行组合测试的这些值。目前的分析表明,当考虑串联测试时,特异性会提高,而当考虑并联组合时,灵敏度也会提高。

更新日期:2022-08-23
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