上腕二頭筋長頭腱病変に対する各種臨床検査の診断精度

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Disorders of the biceps long-head tendon(LHB) can be one of the sources of pain after rotator-cuff repairs. It is important to evaluate the presence of LHB disorders preoperatively, in order to minimize or manage the postoperative shoulder pain. However, they are difficult to be assessed by MRI and physical examinations. Therefore, we used ultrasonography(US) to evaluate the LHB lesion, and analysed the diagnostic values of clinical examinations. We performed ultorasonographic evaluation of 122 shoulders of 61 outpatients over the age of 50. One patient (2 shoulders) was removed from this study because of poor study of US due to the patients obesity. Therefore, final objectives were 120 shoulders of 60 patients. We also tested Speeds test, Yergasons test and the tenderness of the bicipital groove (TD) of all patients and analysed the sensitivity, specificity and positive and negative predictive values(PPV, NPV) of each test. 56 out of 122 shoulders had the LHB lesions under the US, including 19 effusions, 4 effusions+subluxations, 5 subluxations, 4 natural tenodesis, 13 hypertrophies + subluxations, 2 dislocations, and 9 tears. LHBs were difficult to detect in 2 shoulders of 1 obese patient. Sensitivities of Speeds test, Yergasons and TD for the LHB lesion by US were 16.1%, 5.3% and 39.3%, respectively. Specificities of each test were 95.3%, 96.9%, 79.7%. The PPVs and NPVs were 75.0%, 60.0%, 62.9% and 56.5%, 53.9%, 60.0%, respectively. Specificities of each physical examination were high but those sensitivities, PPVs and NPVs were low, as previously reported. The results confirmed the low reliabilities of Speeds test, Yergasons test and TD. LHB lesions at bicipital grooves, which are difficult to be evaluated by MRI or arthroscopy, can be easily and accurately detected by US.

上腕二頭筋長頭腱病変に対する各種臨床検査の診断精度

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