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. 2024 Oct 15;11(4):e70050.
doi: 10.1002/jeo2.70050. eCollection 2024 Oct.

MRI findings and clinical testing for preoperative diagnosis of long head of the biceps pathology

David Gallinet  1   2   3 , Maxime Antoni  4   5 ; ReSurg; Julien Berhouet  3   6 , Christophe Charousset  3   7 , Jacques Guery  3   8
Collaborators, Affiliations

MRI findings and clinical testing for preoperative diagnosis of long head of the biceps pathology

David Gallinet et al. J Exp Orthop. .

Abstract

Purpose: Determine whether combining magnetic resonance imaging (MRI) observations and clinical tests could substantially improve sensitivity for diagnosis of long head of the biceps tendon (LHBT) pathology.

Methods: The authors retrospectively assessed a consecutive series of 140 patients who underwent arthroscopic rotator cuff repair for isolated supraspinatus tears. The presence of LHBT pathology was assessed preoperatively on MRI using three criteria and four clinical tests specific to shoulder injuries. Binary outcomes of MRI observations and four clinical tests were combined to identify combinations resulting in the best sensitivity using intra-operative arthroscopic findings as reference.

Results: The study cohort comprised 100 shoulders (58 men and 42 women) aged 56.6 ± 9.4 years (range, 30-76) at index surgery. A total of 29 combinations were tested to obtain the best diagnostic algorithm for LHBT pathologies. Only four combinations reached a sensitivity ≥0.75, but had a specificity <0.45. The 'Speed or Signal' combination achieved the highest sensitivity (Se: 0.88; 95% confidence interval [CI]: 0.73%-0.96%; Sp: 0.20; 95% CI: 0.10%-0.33%).

Conclusion: The most important findings of this study were that, for the diagnosis of LHBT pathology using clinical tests alone, the Speed test had the highest sensitivity (Se, 0.74), and using MRI observations alone, the signal intensity had the highest sensitivity (Se, 0.68). Combination of 'Speed test or Signal intensity' substantially improved the sensitivity (Se, 0.88) but yielded the lowest specificity (Sp, 0.20). The clinical relevance of these findings is that using the combination 'Speed or Signal' for preoperative diagnosis, 88% of pathologic LHBTs would be correctly diagnosed, while 80% of healthy LHBTs could be misdiagnosed as pathologic.

Level of evidence: Diagnostic study, Level IV.

Keywords: clinical tests; long head of biceps; magnetic resonance imaging; rotator cuff; tendinopathy.

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Conflict of interest statement

David Gallinet reports consulting and royalties from moveUP outside the submitted work. Maxime Antoni reports fees from ConMed and fees and royalties FX Shoulder Solutions outside the submitted work. Julien Berhouet reports consulting for Wright Medical outside the submitted work. Jacques Guery reports fees from moveUP outside of the submitted work. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart following PRISMA guidelines.
See this image and copyright information in PMC

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