Grassbaugh Jason A, Bean Betsey R, Greenhouse Alyssa R, Yu Henry H, Arrington Edward D, Friedman Richard J, Eichinger Josef K
Madigan Army Medical Center, Tacoma, WA, USA.
Irwin Army Community Hospital, Fort Riley, KS, USA.
J Shoulder Elbow Surg. 2017 Aug;26(8):1416-1422. doi: 10.1016/j.jse.2017.01.009. Epub 2017 Mar 27.
Arthroscopic examination of the tendon has been described as the "gold standard" for diagnosis of tendinitis of the long head of the biceps (LHB). An arthroscopic finding of an inflamed and hyperemic LHB within the bicipital groove has been described as the "lipstick sign." Studies evaluating direct visualization in diagnosis of LHB tendinitis are lacking.
During a 1-year period, 363 arthroscopic shoulder procedures were performed, with 16 and 39 patients prospectively selected as positive cases and negative controls, respectively. All positive controls had groove tenderness, positive Speed maneuver, and diagnostic ultrasound-guided bicipital injection. Negative controls had none of these findings. Six surgeons reviewed randomized deidentified arthroscopic pictures of enrolled patients The surgeons were asked whether the images demonstrated LHB tendinitis and if the lipstick sign was present.
Overall sensitivity and specificity were 49% and 66%, respectively, for detecting LHB tendinitis and 64% and 31%, respectively, for erythema. The nonweighted κ score for interobserver reliability ranged from 0.042 to 0.419 (mean, 0.215 ± 0.116) for tendinitis and from 0.486 to 0.835 (mean, 0.680 ± 0.102) for erythema. The nonweighted κ score for intraobserver reliability ranged from 0.264 to 0.854 (mean, 0.615) for tendinitis and from 0.641 to 0.951 (mean, 0.783) for erythema.
The presence of the lipstick sign performed only moderately well in a rigorously designed level III study to evaluate its sensitivity and specificity. There is only fair agreement among participating surgeons in diagnosing LHB tendinitis arthroscopically. Consequently, LHB tendinitis requiring tenodesis remains a clinical diagnosis that should be made before arthroscopic examination.
关节镜检查肌腱被描述为诊断肱二头肌长头（LHB）肌腱炎的“金标准”。关节镜检查发现肱二头肌沟内的LHB发炎和充血被称为“口红征”。缺乏评估直接可视化在LHB肌腱炎诊断中的研究。
在1年期间，进行了363例关节镜下肩部手术，分别前瞻性选择16例和39例患者作为阳性病例和阴性对照。所有阳性对照均有沟压痛、Speed试验阳性以及诊断性超声引导下肱二头肌注射。阴性对照无这些表现。6名外科医生查看了入选患者的随机匿名关节镜图像。询问外科医生图像是否显示LHB肌腱炎以及是否存在口红征。
检测LHB肌腱炎的总体敏感性和特异性分别为49%和66%，检测红斑的敏感性和特异性分别为64%和31%。观察者间可靠性的非加权κ评分在肌腱炎方面为0.042至0.419（平均，0.215±0.116），在红斑方面为0.486至0.835（平均，0.680±0.102）。观察者内可靠性的非加权κ评分在肌腱炎方面为0.264至0.854（平均，0.6l5），在红斑方面为0.641至0.951（平均，0.783）。
在一项严格设计的III级研究中，评估其敏感性和特异性时，口红征的表现仅为中等。参与的外科医生在关节镜诊断LHB肌腱炎方面仅有一般的一致性。因此，需要进行腱固定术的LHB肌腱炎仍然是一种应在关节镜检查前做出的临床诊断。
