PARTIAL BICEPS TEAR- DIAGNOSTIC ACCURACY OF VARIOUS PHYSICAL TESTS

Abstract

Aim: The diagnosis of partial biceps tears cannot be made reliably with existing physical exam tests. Diagnostic arthroscopy is recommended if this diagnosis is suspected.

The accuracy of the physical examination for biceps pathology remains controversial. The goal of this study was to investigate the validity and clinical usefulness of various physical tests used for diagnosing partial tears of the biceps tendon.

Materials & Methods: The study was a prospective blinded study of 847 consecutive patients who underwent arthroscopic procedures for a variety of shoulder conditions. Forty subjects were found at the time of arthroscopy to have partial biceps tears (24 men and 16 women) with an average age of 59 YO (range from 18 to 83 YO). A pre-operative physical examination using 9 different commonly used tests was performed for all the patients. Statistical analysis included sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and likelihood ratios (LR) for these tests.

Results: The prevalence rate of partial tears was 5 percent of all arthroscopic procedures. Associated conditions included rotator cuff tears (85 percent) and anterior instability (7.5 percent). The sensitivity, specificity, PPV, NPV and the LR for the Speed_s test were 50 percent, 67 percent, 8 percent and 96 percent and 1.51, respectively. None of the other tests was sensitive (less than 50 percent). The lift-off sign had a LR of 2.61 but had a sensitivity of only 28 percent.

Conclusion: The diagnosis of partial biceps tears cannot be made reliably with existing physical exam tests. Diagnostic arthroscopy is recommended if this diagnosis is suspected.