What is the clinical value of long head of biceps tendon tests in distal supraspinatus tendon rupture? A prospective multicenter study

Abstract

Background: The purpose of this study was to determine the clinical value of diagnostic tests for the long head of the biceps tendon (LHBT) injuries in the setting of a Patte stage 1 supraspinatus tendon rupture.

Methods: This was a prospective cohort multicenter study of 361 patients aged 30-80 years with Patte stage 1 distal supraspinatus tendon rupture. The LHBT was assessed clinically by palpation of the bicipital groove, the Speed test, the Yergason test and the Kibler test. Under arthroscopy, a rigorous static and dynamic analysis of the long head of the biceps tendon was performed in order to define its pathologic character, or healthy character, without or with so-called minor injuries. The anterior extension of the supraspinatus tendon rupture was also analyzed, especially with Jobe test.

Results: The Speed test had the highest sensitivity (74.5%) for diagnosing pathologic biceps. When combined with palpation of the bicipital groove, the sensitivity increased to 85%. The Kibler test had the highest specificity (74.7%). Combined in series with the Yergason test, the specificity increased to 87.2%. In case of anterior extension of the supraspinatus tendon rupture and to demonstrate an LHBT lesion, the Kibler test had the highest post-test probabilities with a positive likelihood ratio of 2.030 for pathological LHBT and 1852 for minor injuries of LHBT. The pathologic biceps group had a significantly higher mean age (P < .0001), BMI (P = .018), diabetes prevalence (P = .009), and proportion of supraspinatus tendon lesions with anterior extension (P < .0001) CONCLUSIONS: The Kibler test is the most efficient test for the diagnosis of LHBT lesions. Its combination with palpation of the bicipital groove increases its clinical value in the pathologic group. The anterior extension of a lesion of the supraspinatus tendon may nevertheless make these tests positive, even though the LHBT is macroscopically healthy. Older age, overweight, and diabetes should be major predictors of LHBT injury.

Keywords: Kibler test; Long head of biceps; Speed test; Yergason test; bicipital groove; shoulder examination; supraspinatus tendon rupture.