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Fig. 3. Hierarchical summary receiver operating characteristic (ROC) curve examining the diagnostic value of high-resolution ultrasound (HRUS)
for characterization of long head of the biceps tendon (LHBT) (A) dislocation and (B) complete rupture. The 95% prediction region is defined by
the blue dotted-curve, while the red dot-dashed-curve marks the boundary of the 95% credible interval of the pooled estimates. Prediction region
is defined by pairing the confidence interval with the credible interval.
Sn and Sp ranged or were for each test, respectively:
from 0.60 to 0.91 and from 0.13 to 0.85 for the active
compression test (35, 37, 39), from 0.10 to 0.48 and
from 0.81 to 0.82 for anterior slide test (37, 39), 0.55
and 0.53 for biceps load II test (35), from 0.13 to 0.39
and from 0.67 to 0.83 for crank test (36, 39), from 0.58
to 0.89 and from 0.31 to 0.98 for dynamic labral shear
test (35, 37, 41), 0.27 and 0.75 for labral tension test
(35), 0.48 and 0.52 for palpation test (36), 0.82 and 0.86
for passive compression test (45), from 0.09 to 0.47
and from 0.56 to 0.74 for Speed test (35–37, 39), and
0.23 and 0.57 for uppercut test (37). Data were pooled
from studies assessing the Speed test (Table V, Fig. 4).
The results indicate a widely variable performance.
Its point estimates for Sn and Sp are 0.36 (95% CI
0.00–0.82) and 0.71 (95% CI 0.23–1.00), respectively.
SLAP II–IV lesions. Accuracy for diagnosing SLAP
II–IV lesions was assessed for 8 OSTs (Fig. S3 1 ). The
Sn and Sp for each test were, respectively, from 0.47 to
0.65 and from 0.38 to 0.92 for the active compression
test, (22, 25, 27, 31, 38–40), from 0.04 to 0.70 and from
0.69 to 0.98 for anterior slide test (22, 27, 31, 38–40),
from 0.29 to 0.90 and from 0.78 to 0.97 for biceps load
II test (31, 46), from 0.09 to 0.83 and from 0.42 to 1.00
for crank test (22, 26, 27, 39), from 0.25 to 0.26 and
from 0.65 to 0.80 for palpation test (27, 31), 0.89 and
0.82 for passive compression test (45), 0.52 and 0.94
for passive distraction test (40), and from 0.04 to 0.48
and from 0.65 to 1.00 for Speed test (27, 31, 39).
Data were pooled from studies assessing the active
compression test, the anterior slide test and the crank
test (Table V, Fig. 4). The results indicate a widely
variable performance for the 3 tests. The pooled Sn and
Sp for the active compression test are 0.59 (95% CI
0.19–0.96) and 0.57 (95% CI 0.18–0.96), respectively,
for the anterior slide test 0.21 (95% CI 0.00–0.79) and
0.88 (95% CI 0.35–1.00), respectively, and for the
crank test 0.49 (95% CI 0.02–1.00) and 0.70 (95% CI
0.06–1.00), respectively.
Tendinopathy. Accuracy for diagnosing LHBT tendi-
nopathy was assessed for 3 OSTs, and HRUS was the
reference standard. The Sn and Sp estimates from each
study are shown in forest plots (Fig. S4 1 ). The Sn and
Sp were for each test, respectively: from 0.57 to 0.85
and from 0.49 to 0.72 for the palpation test, (30, 47),
from 0.47 to 0.83 and from 0.36 to 0.75 for Speed test
(47-49), and from 0.32 to 0.86 and from 0.74 to 0.82
for Yergason’s manoeuvre (47–49).
Table V. Overall orthopaedic special tests’ accuracy in characterization of long head of the biceps tendon (LHBT) pathology
Studies, n
SLAP I–IV lesions
Speed test
SLAP II–IV lesions
Active compression test
Anterior slide test
Crank test
Any LHBT pathology except SLAP lesion
Speed test
Yergason’s manoeuvre
Shoulders, n
Sensitivity (95% CI) Specificity (95% CI) LR+ LR–
4 380 0.36 (0.00–0.82) 0.71 (0.23–1.00) 1.24 0.90
7
6
4 1,151
1,060
248 0.59 (0.19–0.96)
0.21 (0.00–0.79)
0.49 (0.02–1.00) 0.57 (0.18–0.96)
0.88 (0.35–1.00)
0.70 (0.06–1.00) 1.37
1.75
1.63 0.72
0.90
0.73
7
5 1,542
559 0.65 (0.17–1.00)
0.41 (0.14–0.72) 0.61 (0.15–1.00)
0.84 (0.65–1.00) 1.67
2.56 0.57
0.70
SLAP: superior labrum anterior and posterior; 95% CI: 95% confidence interval; LR+: positive likelihood ratio; LR–: negative likelihood ratio.
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