Sensitivity of Physical Examination Versus Arthroscopy in Diagnosing Subscapularis Tendon Injury

Abstract

The purpose of this study was to examine the accuracy of physical examination in the detection of subscapularis tendon tears and compare it with the gold standard of arthroscopy to determine whether clinical examination can reliably predict the presence of subscapularis tendon tears. This was a retrospective analysis of 52 patients (52 shoulders) who underwent arthroscopic subscapularis tendon repairs between September 2008 and April 2012. Positive findings on any combination of the belly press, lift-off, and bear hug tests constituted a positive physical examination result. There was a positive finding on physical examination in 42 of 52 patients. The sensitivity of the physical examination as a whole was 81%. The literature has shown that the belly press, bear hug, and lift-off tests are specific to the subscapularis tendon. To the authors’ knowledge, this is the first study to evaluate the sensitivity of these 3 separate clinical tests as a composite. Knowledge regarding the sensitivity of the subscapularis-specific physical examination as a composite can lead practitioners to implement all 3 components, even when 1 test has a negative finding, thus promoting a more thorough physical examination. Because unrepaired subscapularis tendon tears can result in poor outcomes in the repair of other rotator cuff tendons, a complete physical examination would be beneficial to patients with shoulder pathology. The authors conclude that physical examination, when performed consistently by an experienced practitioner, can reliably predict the presence of subscapularis tendon tears.

The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear

“…This search yielded 3 additional published studies 2627,28 on this topic since the time frame covered by Hegedus articles. A study by Faruqui 29 was excluded because it reported on sensitivity of belly press, lift-off, and bear hug tests combined (and not as individual tests). In addition to the diagnostic accuracy characteristics reported by the authors in their respective manuscripts, when possible, additional diagnostic accuracy parameters (sensitivity, specificity, likelihood ratios, and predictive values) not reported in the original manuscript were calculated.…”

Combined clinical test and magnetic resonance imaging have similar diagnostic values in the diagnosis of subscapularis tear

“…It has been reported that all 3 tests are equally effective in testing SSc integrity and concluded that surgeons could use any of the 3 tests in the diagnosis of SSc tear [24]. In a study of 52 patients who underwent arthroscopic SSc repair, Faruqui et al [9] have found the sensitivity as 81% when all tests are evaluated together. In a recent study, Kappe et al [16] have found that the sensitivity for combined test is 66%, while the specificity is 82%.…”

Diagnostic Accuracy of Clinical Tests for Subscapularis Tears: A Systematic Review and Meta-analysis

“…Existing studies reporting the diagnostic accuracy of clinical tests for combined IRTT and belly-press test 1 and combined belly-press, bear-hug, and lift-off tests 9 yielded mixed results, with sensitivity of 0.46 and 0.81, respectively. An electromyographic study 31 found that the belly-press, bear-hug, and lift-off tests all activate the integrity of the subscapularis and concluded that these 3 tests can be used interchangeably.…”