Department for Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany.
Knee Surg Sports Traumatol Arthrosc. 2018 Jan;26(1):176-181. doi: 10.1007/s00167-017-4617-4. Epub 2017 Jul 4.
Tears of the subscapularis (SSC) tendon constitute a diagnostic challenge. The purpose of the present study was to evaluate the diagnostic capabilities of five clinical SSC tests.
Five established clinical tests were evaluated in 106 consecutive patients prior to shoulder arthroscopy. The tests included the Lift Off Test, Internal Rotation Lag Sign, Belly Press Test, Belly Off Sign, and Bear Hug Test. The integrity of the SSC tendon at surgery was used as the gold standard. Lesions to the SSC were graded according to Fox and Romeo.
There were 32 SSC lesions accounting for an incidence of 30.2%. The sensitivity for all tests was 0.66, while the specificity was 0.82. For all tests, positive tests results were found to be dependent on subscapularis integrity (p < 0.001, respectively). The sensitivity for any type of SSC lesion for the Lift Off Test, Internal Rotation Lag Sign, Belly Press Test, Belly Off Sign, and Bear Hug Test was 0.35, 0.41, 0.34, 0.31, and 0.52, respectively. Specificity was found to be 0.98, 0.91, 0.96, 0.97, and 0.85, respectively. If only grade 2-4 tears were analysed, sensitivity was 0.32, 0.42, 0.37, 0.37, and 0.72 and specificity 0.94, 0.86, 0.92, 0.94, and 0.84. A positive correlation was found between the number of positive tests and the severity of the SSC lesions.
In the present study, the Bear Hug Test was found to have the highest sensitivity of all tests studied, especially for tears of the upper tendon border. It appears advisable to perform more than one clinical subscapularis test to further improve sensitivity. Nevertheless, SSC tears may still escape clinical recognition. Therefore, a high index of suspicion has to be maintained in order not to miss SSC tears.
Diagnostic study, Level I.
肩胛下肌（SSC）肌腱撕裂是一个诊断难题。本研究旨在评估五种临床 SSC 测试的诊断能力。
在肩关节镜检查前，对 106 例连续患者进行了五种已建立的临床测试评估。这些测试包括抬起测试、内旋滞后征、腹部按压测试、腹部离征和熊抱测试。手术中 SSC 肌腱的完整性用作金标准。根据 Fox 和 Romeo 对 SSC 损伤进行分级。
有 32 例 SSC 损伤，发生率为 30.2%。所有测试的敏感性为 0.66，特异性为 0.82。对于所有测试，阳性测试结果均与肩胛下肌完整性相关（分别为 p<0.001）。对于任何类型的 SSC 病变，抬起测试、内旋滞后征、腹部按压测试、腹部离征和熊抱测试的敏感性分别为 0.35、0.41、0.34、0.31 和 0.52，特异性分别为 0.98、0.91、0.96、0.97 和 0.85。如果仅分析 2-4 级撕裂，敏感性分别为 0.32、0.42、0.37、0.37 和 0.72，特异性分别为 0.94、0.86、0.92、0.94 和 0.84。阳性测试的数量与 SSC 病变的严重程度之间存在正相关。
在本研究中，熊抱测试发现所有研究测试中具有最高的敏感性，尤其是对上部肌腱边界的撕裂。建议进行多项临床肩胛下肌测试以进一步提高敏感性。然而，SSC 撕裂仍可能逃脱临床识别。因此，必须保持高度怀疑指数，以免错过 SSC 撕裂。
诊断研究，I 级。
