Samuele Passigli – Fisioterapista, OMT

hamstring injuryLe lesioni degli hamstring rappresentano una delle lesioni dei tessuti molli più frequenti negli atleti. La valutazione si basa tradizionalmente su palpazione, test manuali di valutazione muscolare e straight leg raise passivo, nonostante non siano presenti informazioni sufficienti per quantificare l’abilità clinica di questi test nel differenziare i soggetti con e senza lesione muscolare. La risonanza magnetica e l’ecografia rappresentano lo standard di riferimento per la diagnosi, ma a causa dell’elevata incidenza e per i costi non sono un’alternativa pratica per la diagnosi.
Solamente tre studi hanno descritto test clinici riportando i valori di sensibilità (SN) e specificità (SP). L’accuratezza diagnostica dei test indagati è molto variabile, con SN compresa tra 0.55 e 1.00 e SP tra 0.03 e 1.00. Inoltre, lo scarso numero di studi preclude una meta-analisi.
La valutazione del dolore posteriore della coscia può essere complessa. Un’anamnesi dettagliata e, in alcuni casi, la valutazione della colonna lombare, del bacino e del sistema nervoso può aiutare nell’escludere red flag e nel differenziare una lesione muscolare da altri disordini. Il rule out/rule in della colonna lombare può essere eseguito con i movimenti ripetuti, con lo slump test e con il straight leg raise test. Le disfunzioni dell’articolazione sacroiliaca e la sindrome del piriforme possono essere escluse con il cluster di test proposto da Laslett e con il test FAIR.
Gli studi futuri dovrebbero investigare un cluster di test per una diagnosi accurata delle lesioni degli hamstring.

Diagnostic accuracy of clinical tests for assessment of hamstring injury: a systematic review. Reiman MP, Loudon JK, Goode AP. J Orthop Sports Phys Ther. 2013;43(4):222-31.

Abstract
STUDY DESIGN:
Systematic literature review.
BACKGROUND:
The diagnosis of a hamstring injury has traditionally relied on various clinical measures (eg, palpation, swelling, manual resistance), as well as the use of diagnostic imaging. But a few studies have suggested the use of specific clinical tests that may be helpful for the diagnostic process.
OBJECTIVE:
To summarize the current literature on the diagnostic accuracy of orthopaedic special tests for hamstring injuries and to determine their clinical utility.
METHODS:
A computer-assisted literature search of the MEDLINE, CINAHL, and Embase databases (along with a manual search of grey literature) was conducted using key words related to diagnostic accuracy of hamstring injuries. To be considered for inclusion in the review, the study required (1) patients with hamstring or posterior thigh pain; (2) a cohort, case-control, or cross-sectional design; (3) inclusion of at least 1 clinical examination test used to evaluate hamstring pathology; (4) comparison against an acceptable reference standard; (5) reporting of diagnostic accuracy of the measures (sensitivity [SN], specificity [SP], or likelihood ratios); and (6) publication in English. SN, SP, and positive and negative likelihood ratios were calculated for each diagnostic test.
RESULTS:
The search strategy identified 602 potential articles, of which only 3 articles met the inclusion criteria, with only 1 of these 3 articles being of high quality. Two of the studies investigated a single special test, whereas the third article examined a composite clinical assessment employing various special tests. The SN values ranged from 0.55 (95% confidence interval [CI]: 0.46, 0.69) for the active range-of-motion test to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test. The SP values ranged from 0.03 (95% CI: 0.00, 0.22) for the composite clinical assessment to 1.00 (95% CI: 0.97, 1.00) for the taking-off-the-shoe test, active range-of-motion test, passive range-of-motion test, and resisted range-of-motion test. The use of a single special test demonstrated stronger SP than SN properties, whereas the composite clinical assessment demonstrated stronger SN than SP properties.
CONCLUSION:
Very few studies have investigated the utilization of clinical special tests for the diagnosis of hamstring injuries. Further studies of higher quality design are suggested prior to advocating independent clinical utilization of these special tests.
LEVEL OF EVIDENCE:
Diagnosis, level 3b.J Orthop Sports Phys Ther 2013;43(4):222-231. Epub 14 January 2013. doi:10.2519/jospt.2013.4343.

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