Fluid Motion Physiotherapy 2012 Ltd, Mahone Bay, Nova Scotia, Canada.
Am J Sports Med. 2013 Sep;41(9):1998-2004. doi: 10.1177/0363546513493383. Epub 2013 Jun 26.
Diagnosis of complete distal biceps tendon rupture (DBTR) is frequently missed or delayed on clinical examination. No single clinical test, including MRI, has demonstrated 100% efficacy in assessing the integrity of the distal biceps tendon.
Combining 3 validated clinical tests for identifying complete rupture can maximize a true-positive diagnosis for complete DBTR without the need for confirmatory soft tissue imaging when performed in concert with other important factors from the history and clinical examination.
Cohort study (diagnosis); Level of evidence, 2.
The hook test, the passive forearm pronation (PFP) test, and the biceps crease interval (BCI) test were applied in sequence in conjunction with a standard patient history and physical examination on 48 patients with suspected distal biceps tendon injuries. If results on all 3 special tests were positive for complete rupture, the patient was referred for surgical repair; diagnosis was confirmed intraoperatively. If results on all 3 special tests were negative, diagnosis was confirmed with soft tissue imaging and patients were managed nonoperatively. If results of the 3 tests were not in agreement, soft tissue imaging was used to clarify the disagreement and to confirm the diagnosis.
Thirty-five patients had unequivocal results based on history, physical examination, and special tests. Thirty-two tested in agreement positive for complete rupture, which were confirmed intraoperatively. Three tested in agreement negative, with subsequent imaging confirming partial rupture. Thirteen patients had equivocal special test results; soft tissue imaging suggested complete rupture in 10 and partial rupture in 3.
Application in sequence of the hook test, the PFP test, and the BCI test results in 100% sensitivity and specificity when the outcomes on all 3 special tests are in agreement.
临床上常漏诊或延迟诊断完全性肱二头肌长头肌腱断裂（DBTR）。包括 MRI 在内的任何单一临床检查都未能证明 100%有效地评估肱二头肌长头肌腱的完整性。
联合使用 3 种经验证的临床检查来识别完全断裂，可以在与病史和临床检查的其他重要因素协同作用时，最大限度地提高完全性 DBTR 的真阳性诊断，而无需进行确认性软组织成像。
队列研究（诊断）；证据水平，2 级。
对 48 例疑似肱二头肌长头肌腱损伤的患者进行标准病史和体格检查，并依次进行钩试验、被动前臂旋前（PFP）试验和肱二头肌皱襞间隙（BCI）试验。如果所有 3 项特殊检查的结果均提示完全断裂，则将患者转至外科修复；术中确诊。如果所有 3 项特殊检查的结果均为阴性，则通过软组织成像确诊，并进行非手术治疗。如果 3 项检查结果不一致，则使用软组织成像来明确分歧并确认诊断。
35 例患者根据病史、体格检查和特殊检查有明确的结果。32 例检查结果一致为完全断裂，术中得到证实。3 例检查结果一致为阴性，随后的影像学检查证实为部分断裂。13 例患者的特殊检查结果不确定；软组织成像提示 10 例完全断裂，3 例部分断裂。
当所有 3 项特殊检查的结果一致时，钩试验、PFP 试验和 BCI 试验的连续应用具有 100%的敏感性和特异性。
