Journal of Rehabilitation Medicine 51-7 | Page 14

Examination of the LHBT in the clinical setting dislocation with HRUS, (ii) LHBT complete rupture with HRUS, (iii) SLAP I–IV lesions with the Speed test, (iv) SLAP II–IV lesions with the active compres- sion test, the anterior slide test and the crank test, (v) any pathology of proximal LHBT except SLAP lesion with the Speed test and the Yergason’s manoeuvre. 483 HRUS accuracy Tendinopathy. Three studies evaluated HRUS for diagnosing LHBT tendinopathy, either with surgery or MRI as reference standard (33, 34, 43). While Sn estimates ranged from 0.22 to 1.00, Sp varied from 0.88 to 1.00 (Fig. S1 1 ). Fig. 2. Methodological quality graph for accuracy studies: (A) all, (B) high-resolution ultrasound (HRUS), and (C) orthopaedic special tests (OSTs). Graphs show the percentage and number of studies with a high (red), low (green) and unclear (yellow) risk of bias for the 4 items. studies assessment shows some risk of bias in 3 of the 4 categories (Fig. 2). For patient selection, 53% of all studies were assessed as low risk. Nine studies were judged at high risk because of restricted population (n = 5) (23–27), inappropriate exclusions (n = 3) (28–30) and case-control study design (n = 1) (31). In addition, three of them did not enrol patients in a consecutive manner (26, 27, 30). For index test, beside inadequate test description (n = 1) (23) and unknown blinding to the reference standard (n = 2) (26, 32), all were assessed as low risk of bias. For reference standard, 33% of studies included had a low risk of bias. All studies judged as high risk had a blinding issue (n = 14) (23, 25, 29, 31–41). For flow and timing, 27% of the eligible studies were deemed to have low risk. All studies considered to have high risk had inadequate interval between index test and reference standard (n = 8) (22, 25, 26, 32–35, 42). Moreover, for 3 of them, the reference standard was not the same for all patients. Findings Few studies compared the same index test with the same reference standard for the same target condition. Therefore, meta-analyses could be considered only for the following combinations: diagnosis of (i) LHBT Dislocation. Seven studies assessed the accuracy of HRUS for diagnosing LHBT dislocation, comparing with surgery or MRI (23, 24, 32, 33, 42–44). Sn varied from 0.33 to 1.00, while Sp was in the high end of the spectrum, ranging from 0.96 to 1.00 (Fig. S1 1 ). Data from the 7 studies were pooled (Table IV, Fig. 3). Point estimates for Sn and Sp are 0.76 (95% CI 0.15–1.00) and 0.98 (95% CI 0.65–1.00), respectively. Results indicate a quite high Sp but more fluctuating Sn. Effusion. One study evaluated HRUS accuracy in diag- nosing LHBT effusion compared with MRI (43). The Sn and Sp estimates were 0.79 and 0.73, respectively (Fig. S1 1 ). Partial rupture. Two studies investigated HRUS ac- curacy for the diagnosis of LHBT partial tear, and com- parison was made with surgery (32, 34). Sn ranged from 0.27 to 1.00 and Sp was 1.00 for both studies (Fig. S1 1 ). Complete rupture. Five studies evaluated HRUS in diagnosing complete LHBT rupture, compared with surgery or MRI (24, 32–34, 42). Sn and Sp ranged from 0.64 to 1.00 and 0.87 to 1.00, respectively (Fig. S1 1 ). Data from the 5 studies were pooled (Table IV, Fig. 3): Sn and Sp are 0.71 (95% CI 0.11–1.00) and 0.98 (95% CI 0.61–1.00), respectively. The results indicate a quite high Sp, but more fluctuating Sn. Orthopaedic special test accuracy SLAP I–IV lesions. Accuracy for diagnosing SLAP I– IV lesions was assessed for 10 OSTs (Fig. S2 1 ). The http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2564 1 Table IV. Overall accuracy of high-resolution ultrasound in characterization of long head of the biceps tendon pathology Pathology n (studies) n (shoulders) Sensitivity (95% CI) Specificity (95% CI) LR+ Dislocation Complete rupture 7 5 624 333 0.76 (0.15–1.00) 0.71 (0.11–1.00) 0.98 (0.65–1.00) 0.98 (0.61–1.00) 38.0 0.24 35.50 0.30 LR– 95% CI: 95% confidence interval; LR+: positive likelihood ratio; LR–: negative likelihood ratio. J Rehabil Med 51, 2019