Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps pathologies - a prospective study.
OBJECTIVE To validate the diagnostic properties of orthopedic tests and qualitative and quantitative high-resolution ultrasound-based (HRUS) assessments in the diagnosis of long head of the biceps tendon (LHBT) pathologies. DESIGN Single blind prospective study evaluating orthopedic tests and HRUS diagnostic performances compared to surgery. SETTING Hospital orthopaedic department. PARTICIPANTS Seventy-one adults scheduled for open or arthroscopic shoulder surgery were included within six weeks of their scheduled surgery. INTERVENTION Participants underwent a preoperative clinical examination, including the Speed's, O'Brien's, Uppercut, and Yergason's tests, and palpation of the bicipital groove, as well as both qualitative and quantitative HRUS evaluation of the LHBT. Afterwards, the LHBT was evaluated during surgery to confirm the diagnosis, with the surgeon blinded from the clinical and HRUS examination. MAIN OUTCOME MEASURE(S) Diagnostic properties were determined for 1) each individual orthopedic test and combinations of tests, 2) qualitative HRUS data alone and in combination with orthopedic tests, and 3) quantitative HRUS data. A receiver operating characteristic (ROC) curve was used to assess the ability of quantitative HRUS to discriminate the presence of LHBT tendinopathy. RESULTS The overall diagnostic performance of the orthopedic special tests was low. Qualitative HRUS exhibited promising diagnostic properties for identifying full-thickness tears (Sensitivity 63%, Specificity 86%) and LHBT dislocation/subluxation (Sensitivity 38%, Specificity 81%). However, combining qualitative HRUS with orthopedic tests and participant age yielded the best properties (i.e., improvement in sensitivity and specificity across all LHBT diagnoses). The diagnostic performance of quantitative HRUS varied depending on the cut-off values used; the best results observed using a maximal surface area greater than 21 mm² (Sensitivity 55%, Specificity 86%). CONCLUSION Qualitative HRUS shows promising diagnostic potential but should be used in conjunction with orthopedic tests. Further research is needed to validate these preliminary results and refine the pathological cut-offs values of quantitative HRUS assessments.