Diagnostic Value of the Supine Napoleon Test for Subscapularis Tendon Lesions

Takeda, Yoshitsugu; Fujii, Koji; Miyatake, Katsutoshi; Kawasaki, Yoshiaki; Nakayama, Takashi; Sugiura, Kosuke

doi:10.1016/j.arthro.2016.04.034

Cited by 16 publications

(15 citation statements)

References 32 publications

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“…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.…”

Section: Discussionunclassified

“…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.…”

Section: Introductionunclassified

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Sutura artroscópica del tendón del subescapular. Técnica y resultados

Gebellí-Jové¹,

Iftimie-Iftime²,

Bel-LLop³

et al. 2018

REACA

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RESUMENObjetivo: mostrar el diagnóstico, la técnica quirúrgica y nuestros resultados de la sutura por vía artroscópica de las roturas completas del tendón del subescapular. Métodos: se han incluido los pacientes intervenidos en nuestro hospital entre los años 2014 y 2016 de rotura completa del tendón del subescapular, comprendiendo tanto las lesiones agudas como crónicas. Para la evaluación se objetivó la movilidad articular y se realizó la escala visual analógica (EVA) para el dolor y el test de Constant-Murley previo a la cirugía, a las 6 semanas, 3 y 6 meses posquirúr-gicos y al alta clínica. Resultados: se incluyen 13 pacientes. Edad media de 57,5 (24-73). El tiempo medio transcurrido entre la lesión y el tratamiento fue de 18 semanas (2-48). El tiempo medio de seguimiento fue de 7 meses (rango: 5-12). El tiempo medio de inmovilización fue de 5,6 semanas (4-6). Realizaron rehabilitación durante 4,2 meses (3-6). La EVA final fue de 0,3 (0-4), el Constant-Murley de 87 (65-95) y, en cuanto a la movilidad, la rotación externa fue de 53,2 (45-60), la flexión anterior de 165,5 (155-180) y la abducción de 162,7 (140-180). Conclusión: en la exploración física no debemos olvidar las maniobras para descartar lesiones del tendón del subescapular. Es una patología que tiene que diagnosticarse y tratarse lo antes posible para tener menor dificultad técnica y obtener mejores resultados. En nuestra serie, los casos agudos se presentan en pacientes más jóvenes, tienen lesiones ABSTRACT Arthroscopic suture of the subscapularis tendon. Technique and resultsObjective: to show the diagnosis, the surgical technique and our results of the arthroscopic suture of the complete tears of the subscapularis tendon with inbox technique. Methods: all patients operated at our hospital between 2014 and 2016 had a complete subscapular tendon rupture, including both acute and chronic injuries. For the evaluation the ranges of movement was recorded and visual analogue scale (VAS) for pain and Constant-Murley score were performed before surgery, 6 weeks, 3, 6 months and at discharge. Results: we included 13 patients. Mean age of 57.5 (24-73). Time elapsed between injury and treatment was 18 weeks (2-48), mean follow-up was 7 months (5-12), mean time for immobilization was 5.6 weeks (4-6). Rehabilitation performed for 4.2 months (3-6). VAS at discharge was 0.3 (0-4), Constant-Murley score 87 (65-95) and in mobility the external rotation was 53.2 (45-60), forward flexion of 165.5 (155-180) and abduction 162.7 (140-180).

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Section: Discussionunclassified

Section: Introductionunclassified

Sutura artroscópica del tendón del subescapular. Técnica y resultados

Gebellí-Jové¹,

Iftimie-Iftime²,

Bel-LLop³

et al. 2018

REACA

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“…However, except IRLS, other 4 clinical tests were investigated only against the surgical reference standard. The lift-off is in 6 studies 49,50,51,52,53,54 total 934 painful shoulders. The diagnostic utility values ranged from 18.8-65.2%, 68.5-98% and 1.9-17.5 respectively.…”

Section: Clinical Tests For Subscapularismentioning

confidence: 99%

Diagnostic accuracy of clinical tests to diagnose subacromial impingement syndrome: A systematic review

S.Thiruvarangan¹,

T.Shaminy²

2021

IJRP

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The aim of this review was to systematically review the cost-effective diagnostic utility of clinical tests to diagnose subacromial impingement syndrome. Data SourcesThe following electronic databases: Medline, EMBASE, Science Direct and the Cochrane Library were searched in June 2020 to identify the studies that investigated the diagnostic accuracy of clinical tests to diagnose SAIS. The search was restricted to articles written in English. Study SelectionThis study included diagnostic accuracy of cohort studies that directly compared the diagnostic utility of clinical tests for diagnosing SAIS against either surgical or indirect imaging reference standards. The PRISMA guidelines were followed to accomplish this review. Two reviewers independently performed the study's methodological quality assessment by using the QUADAS tool. Data ExtractionThe sensitivity and specificity for each clinical test waa extracted from the included studies and both positive and negative likelihood ratios were tabulated either direct from available studies or calculated from the provided sensitivity and specificity data. Data SynthesisThis review included 14 studies in total of 1756 shoulders and considered standard, modified and novel clinical tests for making a differential diagnosis on SAIS. In this review, included studies' overall methodological quality is high and there appears to be the diagnostic utility of the subacromial grinding test, lift-off, bear-hug and belly-off tests provide significant evidence to rule in SAIS when the tests are positive. ConclusionThis is an updated study of a previous systematic review on the diagnostic accuracy of clinical tests for SAIS. Making a precise differential diagnosis will ultimately ensure the appropriate therapeutic interventions, subsequently successful prognosis on SAIS patients thus, this review findings of diagnostic utility clinical tests need to be considered in the context of clinical practice of the overall patient assessment.

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“…According to them, the sensitivity of physical examination as a whole in diagnosing primary subscapularis tears was 81% [7]. In comparison with other clinical tests, Takeda et al found that the bear hug test had the greatest specificity and positive prognostic value [8]. In addition, the Napoleon test had the greatest sensitivity and negative prognostic value [8].…”

Section: Introductionmentioning

confidence: 99%

“…In comparison with other clinical tests, Takeda et al found that the bear hug test had the greatest specificity and positive prognostic value [8]. In addition, the Napoleon test had the greatest sensitivity and negative prognostic value [8]. Finally, Schiefer et al illustrated that the bear hug test had the highest sensitivity and negative predictive values in diagnosing primary subscapularis tears, when compared with the Napoleon test, the belly press and lift-off tests [9].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of Subscapularis Clinical Tests in the Postoperative Diagnosis of Subscapularis Retears: An Ultrasound-Comparative Trial

Fandridis¹,

Malahias²,

Plagou³

et al. 2019

TOORTHJ

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Background: Different physical examination tests have been used to preoperatively determine both the presence and size of a primary subscapularis tear. On the contrary, no clinical trial has yet been published to assess the diagnostic validity of the aforementioned tests in diagnosing subscapularis retears after arthroscopic subscapularis repair. Objective: To investigate the diagnostic value of the most commonly used clinical tests in the diagnosis of subscapularis tendon retears after arthroscopic repair. Methods: A retrospective (prospectively collected data) case series involving 37 patients who were suffering from symptomatic complete subscapularis tendon tear was conducted. All patients underwent an all-arthroscopic subscapularis repair with the same operative technique. They were postoperatively evaluated (final end point of follow-up: 12 months) with the use of ultrasound, Constant-Murlay score (CS), bear hug test, internal rotation lag sign, Napoleon test and lift-off test. Sensitivity, specificity, accuracy, positive and negative prognostic values were calculated for each test. Results: Shoulder function was significantly improved according to the final CS. The internal rotation lag sign was the most sensitive for the diagnosis of postoperative subscapularis retears, while the Napoleon sign had the highest specificity. Although postoperative clinical tests yielded no false negative findings, they were poorly predictive as for new ruptures. Ten patients (27%), who were found with a positive (for re-rupture), postoperative, clinical test, had a sonographically intact subscapularis tendon repair. Conclusion: We strongly support the use of subscapularis-specific clinical tests as a composite, in combination with a specific interpretation of their results. If all tests are found negative for retear, then we could assume that the arthroscopic repair remains intact and no further diagnostic examination might be necessary. On the contrary, if at least one subscapularis-specific clinical test is positive for retear, then the patient will likely require additional imaging control for definite diagnosis.

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Diagnostic Value of the Supine Napoleon Test for Subscapularis Tendon Lesions

Cited by 16 publications

References 32 publications

Sutura artroscópica del tendón del subescapular. Técnica y resultados

Sutura artroscópica del tendón del subescapular. Técnica y resultados

Diagnostic accuracy of clinical tests to diagnose subacromial impingement syndrome: A systematic review

The Diagnostic Value of Subscapularis Clinical Tests in the Postoperative Diagnosis of Subscapularis Retears: An Ultrasound-Comparative Trial

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