Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review

Abstract

LAY ABSTRACTPeople with shoulder pain seek medical attention in order to relieve their symptoms and improve their quality of life. However, given the complexity of the shoulder girdle, making the right diagnosis can be challenging. Clinicians and other healthcare practitioners base their approach on the findings of current medical history, as well as physical and ultrasound examinations. Once a structure is identified as a potential pain-generator, a specific therapy can be used. The biceps tendon is one such structure. The aim of this study is to assess the accuracy of physical and ultrasound examinations in diag nosing biceps tendon pathologies. This will help to guide clinical decision-making and may prevent delay in seeking specific treatment approaches. Objective: To determine the diagnostic validity of high-resolution ultrasound and orthopaedic special tests in diagnosing long head of the biceps tendon pathologies in patients with shoulder pain. Design: Systematic review with meta-analysis tools. Data sources: MEDLINE, CINAHL and EMBASE. Data extraction: Included studies had to report on the diagnostic validity of orthopaedic special tests or high-resolution ultrasound (HRUS) compared with a reference standard for diagnosing long head of the biceps tendon target conditions (superior labrum anterior and posterior lesions, long head of the biceps tendon tendinopathy, dislocation, effusion or rupture). Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool. Results: Of the 30 included studies, 8 focused on high-resolution ultrasound and 22 on orthopaedic special tests. High-resolution ultrasound proved highly specific for the diagnosis of long head of the biceps tendon pathologies. Pooled positive (LR+) and negative (LR-) likelihood ratios were 38.00 and 0.24 for dislocation, respectively, and 35.50 and 0.30 for complete rupture, respectively. The accuracy of orthopaedic special tests varied greatly across studies. The only test of value was Yergason's ma noeuvre in confirming proximal long head of the biceps tendon pathologies except superior labrum anterior and posterior lesion (high specificity): the summary LR+ and LR-were 2.56 and 0.70, respectively. Conclusion: High-resolution ultrasound is reliable to confirm suspected long head of the biceps tendon pathologies. There is insufficient evidence to recommend individual orthopaedic special tests. JRM Journal of Rehabilitation Medicine 480 V. Bélanger et al. SLAP lesion: histopathology, open surgery, arthroscopy and MR arthrography; LHBT tendinopathy: histopathology and open surgery; LHBT rupture or dislocation: histopathology, open surgery, arthroscopy, MR imaging/arthrography and HRUS.If the reference standard used in the study was not in this list, it was considered an unclear risk of bias. Flow and timingA 1-month period in between the index test and reference standard was considered adequate. We chose this cut-off to minimize disease progression bias, since tendon condition can evolve over time. We ar...

Biceps tendon instability with or without pulley tears: an arthroscopic diagnostic study

“…The ramp test successfully detected LHBT instability in case of SGHL insufficiency with grossly intact BRP structure, which is in contrast to the findings of missed underlying BRP lesions and LHBT instability in previous studies without dynamic acquisition. 15,16 This phenomenon may be explained by the fact that refractory anterior shoulder pain is commonly underreported.…”

Commentary on: Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review

“…We commend Bélanger et al (1) on their article en titled "Accuracy of examination of the long head of the biceps tendon in the clinical setting: a systematic review", and for highlighting concerns about the vali dity of orthopaedic special tests (OSTs). However, we respectfully disagree with the utilization of shoulder arthroscopy as an appropriate reference standard for determining the sensitivity and specificity of OSTs in the diagnosis of tendinopathy and/or partial tears of the long head of the biceps tendon (LHBT).…”

“…Our main aim in writing this letter is to highlight the limitations of arthroscopy in the diagnosis of LHBT pathology, particularly that it does not allow visualiza tion of common sites of distal pathology, and that it is associated with a high rate of missed diagnoses. These limitations must be taken into account in interpreting the systematic review published by Bélanger et al (1) in clinical practice, and in future studies seeking to evaluate the diagnostic value of OSTs.…”

Acupuncture for Atraumatic Shoulder Conditions: Protocol for a Systematic Review and Meta-Analysis

“…First, the results of a physical examination of the shoulder are affected by a certain subjectivity of the examiner (9). The sensitivity and specificity of clinical shoulder tests have been reported to fluctuate over a range from 0.21 to 0.82 and 0.53 to 0.98 (11)(12)(13). The interobserver agreement of the diagnosis of shoulder pain was reported to be only 60% (9).…”