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physioscience 2017; 13(03): 102-108
DOI: 10.1055/s-0035-1567213
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Ist die Beweglichkeit der HWS bei Patienten mit chronischem Nackenschmerz eingeschränkt?

Do Patients with Chronic Neck Pain Demonstrate a Restricted Cervical Range of Motion?
U. Wolf
,
S. Mendoza
,
J. Kiselev
,
S. Unverzagt
,
J. Behrens
,
R. P. Franke
Further Information

Publication History

29 May 2016

26 March 2017

Publication Date:
07 September 2017 (online)

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Zusammenfassung

Hintergrund: Die Untersuchung des Bewegungsumfangs ist fester Bestandteil des Assessments bei Patienten mit Nackenschmerz. Bewegungseinschränkungen gelten als sicheres Zeichen für akute Schmerzzustände. Bei chronischem Nackenschmerz ist das Vorhandensein von Bewegungseinschränkungen jedoch fraglich.

Ziel: Die vorliegende Erhebung untersuchte, ob Patienten mit chronischem Nackenschmerz Bewegungseinschränkungen aufweisen.

Methode: 60 gesunde Probanden und 60 Patienten mit chronischem Nackenschmerz wurden mittels Ultraschalltopometrie während zyklischer Bewegungen der HWS bezüglich des Bewegungsumfangs untersucht und die Mittelwerte beider Gruppen auf signifikante Unterschiede überprüft. Ferner erfolgte die Klassifikation der gemessenen Bewegungsumfänge anhand geschlechts- und altersspezifischer Normwerte als normal, hypermobil oder hypomobil. Für die Validität des Befundes „hypomobil“ in Bezug auf die Erkennung des chronischen Nackenschmerzes wurden die Sensitivität, die Spezifität sowie die positive (LR+) und die negative Likelihood Ratio (LR–) ermittelt.

Ergebnisse: Die durchschnittlichen Bewegungsumfänge beider Gruppen unterschieden sich in alle Richtungen signifikant. Im Vergleich zu den Normwerten wiesen mehr als drei Viertel der Teilnehmer beider Gruppen eine normale Beweglichkeit auf. Die Sensitivität des Kriteriums „Hypomobilität“ lag bei maximal 0,23, die Spezifität bei über 0,9, die LR+ bei maximal 0,93 und der niedrigste Wert der LR– bei 0,65.

Schlussfolgerung: Beim chronischen Nackenschmerz ist das Bewegungsausmaß der HWS nicht vermindert. Für das Assessment fehlt ein objektiver Parameter, der mit psychosozialen Variablen korreliert und von Physiotherapeuten gemessen werden kann.

Abstract

Background: Evaluation of the range of motion is a standard procedure in the assessment of patients with neck pain. Restricted movements are considered to be a sure indicator for acute pain. In chronic neck pain the presence of restricted movements is yet doubtful.

Objective: This study examined whether patients with chronic neck pain suffer from restricted movements.

Method: 60 healthy subjects and 60 patients with chronic neck pain were examined during cyclic cervical spinal movements with a view towards range of motion by using ultrasound topometry. The mean amplitude of both groups was analyzed concerning significant differences. In addition, the measured range of motion was classified on the basis of gender and age specific standard values as “normal”, “hypermobile” or “hypomobile”. Concerning the validity of the diagnosis „hypomobile” in relation to the identification of chronic neck pain sensitivity, specificity and positive (LR+) as well as negative likelihood ratio (LR–) were assessed.

Results: The average of the range of motion in both groups varied significantly for all directions. In comparison to standard values more than three thirds of the participants of both groups showed normal range of motion. The sensitivity of the criterion “hypomobility” attained a maximum of 0.23, the specificity of more than 0.9, LR+ a maximum of 0.93 and the lowest performance of LR– was 0.65.

Conclusions: In chronic neck pain the cervical spinal range of motion is not restricted. For the assessment an objective parameter is missing which correlates with psychosocial variables and may be measured by physiotherapists.

Schlüsselwörter

chronischer Schmerz - Nackenschmerz - Physiotherapie - Beweglichkeit - Validität

Key words

chronic pain - neck pain - physiotherapy - mobility - validity
 

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