Diagnostic accuracy of clinical tests directed to the long head of biceps tendon in a surgical population: a combination of old and new tests

Abstract

Background: Our objective was to examine the clinical utility of old and new clinical tests directed to the long head of the biceps tendon (LHBT) and to quantify the importance of proper test interpretation.

Methods: A consecutive 65 patients scheduled to undergo arthroscopic surgery were selected. Before surgery, 5 clinical tests were performed: Speed, Yergason, upper cut, biceps resisted flexion (BRF), and modified BRF (mBRF) using a dumbbell. Pain in an area other than the bicipital groove was noted. The presence of LHBT disease was assessed at arthroscopy, and the clinical utility of the tests was calculated.

Results: The upper cut test was the most sensitive test and the one with the lowest negative likelihood ratio (0.90 and 0.26, respectively); the Yergason test was the most specific and the one with the highest positive likelihood ratio (0.83 and 2.20, respectively). BRF strength did not correlate with an LHBT lesion. The mBRF test has a sensitivity of 0.34 and a specificity of 0.75. Higher age predicted an increased risk of an LHBT lesion (1.2 times). Different interpretations of the tests can result in a difference of up to 29 percentage points in performance (ie, sensitivity).

Conclusion: Our results suggest that the upper cut test should be used as a screening test and that after a positive result, the Speed and the Yergason tests should be used as confirmatory tests.

Keywords: Long head of biceps tendon; clinical utility; shoulder tests; test interpretation.