Journal of Rehabilitation Medicine 51-7 | Page 10

J Rehabil Med 2019; 51: 479–491
REVIEW ARTICLE
ACCURACY OF EXAMINATION OF THE LONG HEAD OF THE BICEPS TENDON IN
THE CLINICAL SETTING: A SYSTEMATIC REVIEW
Valérie BÉLANGER, MD 1 , Frédérique DUPUIS, BSc 2 , Jean LEBLOND, PhD 2 and Jean-Sébastien ROY, PT, PhD 2,3
From the 1 Department of Physical Medicine and Rehabilitation (Physiatry), Centre Hospitalier Universitaire de Québec – Université
Laval, 2 Center for Interdisciplinary Research in Rehabilitation and Social Integration, and 3 Department of Rehabilitation, Faculty of
Medicine, Université Laval, Quebec City, Canada
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 bi-
ceps tendon tendinopathy, dislocation, effusion or
rupture). Risk of bias was assessed using the Qua-
lity 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 ort-
hopaedic special tests varied greatly across studies.
The only test of value was Yergason’s ma­
noeuvre
in confirming proximal long head of the biceps ten-
don 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 recom-
mend individual orthopaedic special tests.
Key words: shoulder; biceps tendon; glenoid labrum; ima-
ging; diagnostic ultrasound.
Accepted May 3, 2019; Epub ahead of print May 16, 2019
J Rehabil Med 2019; 51: 479–491
Correspondence address: Valérie Bélanger, Centre Hospitalier Univer-
sitaire de Québec – Université Laval, Hôpital de l’Enfant-Jésus, 1401,
18e Rue, Quebec City, Canada, G1J 1Z4. E-mail: valerie.belanger.20@
ulaval.ca
S
houlder pain is common in the general population
(1), and pathology of the long head of the biceps
tendon (LHBT) can be a primary source of shoulder
pain, either in isolation or in association with other
shoulder pathologies, such as rotator cuff diseases
LAY ABSTRACT
People with shoulder pain seek medical attention in or-
der 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
diag­nosing biceps tendon pathologies. This will help to
guide clinical decision-making and may prevent delay in
seeking specific treatment approaches.
(2, 3). Most described LHBT pathologies include su-
perior labrum anterior and posterior (SLAP) lesions,
tendinosis, dislocation and rupture (4). In the clinical
setting, orthopaedic special tests (OSTs) and, more
recently, high-resolution ultrasound (HRUS) are
used for ruling in or out shoulder disorders, such as
LHBT pathologies. While numerous OSTs have been
proposed to identify the different LHBT pathologies,
HRUS can be used to detect LHBT tendinopathy,
dislocation, rupture and intra-articular peritendinous
effusion. In rare cases, HRUS can directly diagnose
insertional pathology, such as SLAP lesions (5). Eight
systematic reviews have been published on the di-
agnostic accuracy of OSTs for a wide spectrum of
shoulder disorders, including LHBT pathologies,
most of which were SLAP lesions. The conclusions
were that OSTs are neither very specific nor sensitive
in diagnosing SLAP lesions (6–13). However, new
high-quality diagnostic accuracy studies for OSTs
have been conducted in the past few years, and could
therefore change the conclusions of these previous
systematic reviews. In addition, no systematic review
has focused on the accuracy of HRUS in diagnosing
LHBT pathologies. To our knowledge, no systematic
review has been carried out specifically addressing the
diagnosis of LHBT pathologies in clinical practice,
including the accuracy of both OSTs and HRUS exa-
minations. A better picture of the current accuracy of
clinicians in assessing the LHBT will enable a better
selection of diagnostic tools for the clinical evaluation
of shoulder pain.
This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm
Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977
doi: 10.2340/16501977-2563