Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN, USA.
PM R. 2011 Nov;3(11):1035-40. doi: 10.1016/j.pmrj.2011.02.022. Epub 2011 Jun 25.
To determine the accuracy of palpating the long head of the biceps tendon (LHBT) within the intertubercular groove with the use of ultrasonographic localization as a gold standard.
Prospective, single-blinded pilot study.
Sports medicine clinic at a tertiary care academic institution.
Twenty-five male and female asymptomatic volunteers ages 24-41 years (mean, 30.9 ± 4.3 years) with body mass indices of 19.3 to 36.3 kg/m(2) (23.84 ± 4.8 kg/m(2)).
Three examiners of differing experience (a sports medicine board-certified staff physician, a sports medicine fellow, and a physical medicine and rehabilitation resident) identified the LHBT location in the intertubercular groove via palpation on a subject in the supine position and marked its location by taping an 18-gauge Tuohy needle to the skin overlying the groove. The examiner order was randomized. A fourth examiner who was blinded to the palpation order assessed the previous examiner's palpation accuracy by comparing the needle position to the sonographically determined tendon position.
Needle placement in relation to the intertubercular groove was graded as being within the groove, medial to the groove, or lateral to the groove. In the latter 2 cases, the distance from the needle to the closest groove edge was recorded.
Overall accuracy rate was 5.3% (4/75), ranging from 0% (0/25) for the resident to 12% (3/25) for the fellow (P ≤ .007 for interexaminer differences). All missed palpations were localized medial to the intertubercular groove by an average of 1.4 ± 0.5 cm (range, 0.3 for the fellow to 3.5 cm for the resident).
Based on the current methodology, clinicians have a tendency to localize the intertubercular groove medial to its actual location. Consequently, clinicians should exercise caution when relying on clinical palpation to either diagnose a biceps tendon disorder or perform a bicipital tendon sheath injection. When clinically indicated, sonographic guidance can be used to accurately identify the LBHT within the intertubercular groove.
以超声定位为金标准，确定在结节间沟内触诊长头肱二头肌肌腱（LHBT）的准确性。
前瞻性、单盲先导研究。
三级保健学术机构的运动医学诊所。
25 名年龄在 24-41 岁（平均 30.9 ± 4.3 岁）、体重指数为 19.3 至 36.3kg/m2（23.84 ± 4.8kg/m2）的男女无症状志愿者。
3 名经验不同的检查者（运动医学委员会认证的主治医生、运动医学研究员和物理医学和康复住院医师）在仰卧位受试者身上通过触诊确定结节间沟内的 LHBT 位置，并通过在覆盖沟的皮肤上贴一根 18 号 Tuohy 针标记其位置。检查者的顺序是随机的。第四名检查者对触诊顺序不知情，通过比较针的位置和超声确定的肌腱位置来评估前一位检查者的触诊准确性。
针相对于结节间沟的放置位置被评为在沟内、沟内偏侧或沟外偏侧。在后两种情况下，记录针到最近沟缘的距离。
总体准确率为 5.3%（4/75），范围为住院医师的 0%（0/25）至研究员的 12%（3/25）（不同检查者之间的差异 P ≤.007）。所有漏诊的触诊均位于结节间沟内侧，平均距离为 1.4 ± 0.5cm（范围为研究员的 0.3cm 至住院医师的 3.5cm）。
根据目前的方法学，临床医生倾向于将结节间沟定位于其实际位置的内侧。因此，当临床医生依赖临床触诊来诊断肱二头肌肌腱疾病或进行肱二头肌肌腱鞘注射时，应谨慎行事。在临床需要时，可以使用超声引导来准确识别结节间沟内的 LBHT。
