486
V. Bélanger et al.
from 0.32 to 0.86 and from 0.78 to 0.88 for Yergason’s
manoeuvre (37, 47–49, 51)
Data from studies assessing Speed test and
Yergason’s manoeuvre were pooled (Table V, Fig. 4).
The results indicate a widely variable performance for
the 2 tests, except for Yergason’s manoeuvre Sp. Sn
and Sp for the Speed test are 0.65 (95% CI 0.17–1.00)
and 0.61 (95% CI 0.15–1.00) and for Yergason’s
manoeuvre 0.41 (95% CI 0.14–0.72) and 0.84 (95%
CI 0.65–1.00).
DISCUSSION
We identified 30 studies evaluating the accuracy of
HRUS or OSTs in diagnosing LHBT pathologies (Ta-
ble III). The 8 primary studies on HRUS diagnostic
accuracy comprised 5 different combinations of target
condition/index test. At most, 6 of the studies examined
the same combination. The 22 studies assessing OSTs
presented 26 such combinations, and no more than 7
research studies tested the same combination. This
lack of consistency across studies and the relatively
few studies on the subject are a major barrier to the
assessment of these clinical tools.
Potential of the tests to inform diagnoses
For a diagnostic test to be useful, it must have the
ability to sufficiently revise the pre-test probability
of a patient having a disease in order to guide clinical
decisions. HRUS for the diagnosis of dislocation and
complete rupture had LR+ above 35.5 and LR– be-
low 0.30, indicating a large increase in the post-test
probability of dislocation and complete rupture when
diagnostic ultrasound is positive, and a moderate
decrease in the probability of these diseases when it
is negative (23). It should be noted that estimates of
Sn of HRUS for diagnosing dislocation and complete
rupture had wide confidence intervals (0.15–1.00 and
0.11–1.00), hence their calculated LR– might overplay
the evidence. Confidence intervals were narrower for
Sp (0.65–1.00 and 0.61–1.00), thus LR+ are probably
informative.
OSTs LR+ and LR– demonstrated less compel-
ling evidence. The only test of value was Yergason’s
manoeuvre in diagnosing proximal LHBT pathology
except SLAP lesion. Its LR+ was 2.56, indicating a
slight increase in the probability of the disease. As its
Sp confidence interval was 0.65–1.00, we can assume
that it is of reasonable value. OSTs LR– varied between
0.57 and 0.90, all indicating no change in the post-test
probability of the disease. The current review separated
SLAP I–IV and II–IV lesions as 2 target conditions in
order to investigate whether the accuracy of each OST
www.medicaljournals.se/jrm
changes when SLAP I lesions are considered normal
variants. When explored graphically with forest plots,
there is no apparent significant difference between the
OSTs’ accuracies in diagnosing SLAP I–IV and SLAP
II–IV lesions.
Comparison with other systematic reviews
Eight systematic reviews were identified, of which 4
included a meta-analysis that evaluated the diagnostic
accuracy of OSTs for diagnosing SLAP lesions. The 4
systematic reviews that did not include a meta-analysis
(6, 7, 9, 12) highlighted that OSTs have a wide range
of diagnostic accuracy values, with no particular single
test appearing to have strong statistical support. This is
in line with our conclusions for the accuracy of OSTs.
Hanchard et al. (9) conducted a Cochrane systematic
review on shoulder impingements and local lesions of
tendons and labrum that may accompany impingement.
Their review comprised several individual studies
that were included in our analysis for the accuracy of
OSTs. For these analyses, Sn and Sp were obtained
in agreement with Hanchard et al.’s study. For these
same combinations of index test/target condition, 8
new studies issued after completion of their review
were identified and included (22, 24–30). In addition,
we classified the target conditions slightly differently.
In the current review, we grouped together studies
examining the diagnosis of SLAP II–IV and SLAP II
lesions (our SLAP II–IV group) while Hanchard et al.
kept them separated.
Four previous meta-analyses (8, 10, 11, 13) have
reported pooled accuracy estimates for the active com-
pression test, anterior slide test, crank test and Speed
test in diagnosing SLAP lesions. Hegedus et al. (10)
and Gismervik et al. (8) reviewed the literature on the
accuracy of OSTs of the shoulder. For SLAP lesions,
there were some discrepancies between the values ob-
tained by these authors and our estimates for the active
compression test and Speed test. These discrepancies
may arise from the fact that we separated SLAP I–IV
from II–IV studies. Our higher Sp for active compres-
sion test could suggest that it has a better profile for
confirming a SLAP II–IV than a SLAP I–IV lesion.
In addition, Gismervik et al. incorporated Holtby &
Razmjou’s study (31) when combining data for the
Speed test, while we did not. It should be noted that
Holtby & Razmjou’s study was not included in our
analysis for the combination Speed test/SLAP I–IV
lesions because this study evaluates Speed test’s ac-
curacy in diagnosing not only SLAP lesions, but any
proximal LHBT pathology including SLAP lesions.
Meserve et al. (11) conducted a meta-analysis exami-
ning the accuracy of OSTs for assessing SLAP lesions