Diagnosis of subscapularis tendon tears: Are available diagnostic tests pertinent for a positive diagnosis?

Abstract

Even though all three tests were performed (LOT, BPT, BHT), 24% of the subscapularis tears were only diagnosed during surgery. The role of the Internal Rotation Lag Sign and Belly-Off Sign in improving the diagnosis of tears was not studied in this work.

The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear

“…Prior studies have provided data on individual or only few of the special tests described for the rotator cuff 26,27,30–35 . This issue was addressed in this study by assessing 15 tests commonly used for the diagnosis of rotator cuff tear and biceps pathology.…”

“…Prior studies also had limitations such as recruitment from single sites/providers or data obtained by retrospective chart review 27,28,30,32–36 This study addressed these limitations by recruiting from multiple sites and providers, and recruiting patients prospectively. Prior studies have also used either imaging or surgical findings as reference standard for their case definition of a rotator cuff tear 26–28,30–36 . Although MRI/MRA have high sensitivity and specificity for the diagnosis of rotator cuff tear 37–41 , it is well-documented that rotator cuff tears are present even in asymptomatic individuals 19–22 .…”

“…In addition we also performed a literature search using the MEDLINE, EMBASE, and CINAHL databases for articles published after February 2012 and until March 2014 on sensitivity, specificity, and accuracy of special tests for rotator cuff tear. This search yielded 3 additional published studies 2627,28 on this topic since the time frame covered by Hegedus articles. A study by Faruqui 29 was excluded because it reported on sensitivity of belly press, lift-off, and bear hug tests combined (and not as individual tests).…”

Sutura artroscópica del tendón del subescapular. Técnica y resultados

“…Las lesiones parciales pueden pasar desapercibidas con RMN o ecografía, solo la artro-RMN nos dará un diagnostico más fiable (19) . Por lo tanto, la exploración física sistemática, con maniobras dirigidas a descartar lesiones tanto parciales como totales -teniendo en cuenta que el signo de Napoleón y el bear hug test son las mas sensibles para las lesiones parciales-son muy importantes en nuestra consulta diaria (15)(16)(17) . Y durante la artroscopia tenemos que descartar siempre una posible lesión del tendón del subescapular.…”

“…Es muy importante la exploración física detallada buscando un aumento de la RE y realizando las maniobras específicas: lift off (12) , belly test (13) , the bear-hug test (14) (abrazo del oso) y test de Napoleón (15) . Parece ser que el bear-hug test y el de Napoleón detectan mejor lesiones parciales y el lift off solo es positivo en lesiones completas (14)(15)(16)(17) . La radiografía en las proyecciones estándar ayuda a descartar otras patologías y en la visión de perfil de escápula se puede valorar la morfología de la apófisis coracoides y la distancia coracohumeral.…”