Ultrasound is more reliable than clinical tests to both confirm and rule out pathologies of the long head of the biceps: a systematic review and meta-analysis

Abstract

Purpose To synthesize the literature and critically appraise current evidence to determine the most accurate physical examination (clinical test or ultrasound) to detect pathologies of the long head of the biceps tendon (LHBT). Methods A search was performed on PubMed, Embase®, and Cochrane. Studies that compared the diagnostic accuracy of clinical tests or ultrasound versus arthroscopy for the assessment of LHBT pathologies were included. Results Seven studies were included reporting on a total of 448 patients. One study on instability using ultrasound reported sensitivity and speciicity of 1.00 and 0.96, respectively. Two studies on full-thickness tears using ultrasound reported sensitivity and speciicity of 0.88-0.95 and 0.71-0.98, respectively. Four studies on partial-thickness LHBT tears reported sensitivity and speciicity of 0.17-0.68 and 0.38-0.92, respectively, for clinical tests, versus 0.27-0.71 and 0.71-1.00, respectively, for ultrasound. Three studies on other LHBT pathologies reported sensitivity and speciicity of 0.18-0.79 and 0.53-0.85, respectively, for clinical tests, versus 0.50 and 1.00, respectively, for ultrasound. Conclusion To detect LHBT pathologies, sensitivity is high-to-excellent using ultrasound, and moderate using Neer's sign and Speed's test, while speciicity is high-to-excellent also using ultrasound, as well as the belly press, lift-of and Kibler's tests. The clinical relevance of these indings is that clinical tests are only reliable either to conirm or rule out LHBT pathologies, whereas ultrasound is reliable both to conirm and rule out LHBT pathologies. While diagnostic imaging cannot substitute for patient history and physical examination, the reliability and accessibility of ultrasound render it practical for routine use, particularly if clinical tests render unclear or contradictory indings. Level of evidence Level III.