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