Karanasios Stefanos, Korakakis Vasileios, Moutzouri Maria, Drakonaki Eleni, Koci Klaudia, Pantazopoulou Vasiliki, Tsepis Elias, Gioftsos George
Physiotherapy Department, University of West Attica, Egaleo, Greece.
Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
J Hand Ther. 2022 Oct-Dec;35(4):541-551. doi: 10.1016/j.jht.2021.02.002. Epub 2021 Feb 27.
Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing.
To review the diagnostic accuracy of examination tests used in LET.
Systematic review following PRISMA-DTA guidelines.
We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET.
Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%).
Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies.
PROSPERO ID CRD42020160402.
基于最新的特定背景工具和指南，对外侧肘肌腱病（LET）检查测试诊断性能的综述尚付阙如。
回顾LET中使用的检查测试的诊断准确性。
遵循PRISMA-DTA指南进行系统综述。
我们检索了MEDLINE、PubMed、CINAHL、EMBASE、PEDro、ScienceDirect和Cochrane图书馆数据库。使用QUADAS-2清单评估符合条件研究的方法学质量。我们纳入了报告LET患者使用的体格检查测试或成像方式准确性的诊断研究。
确定了24项研究，共1370名参与者，报告了超声成像（USI）（18项研究）、体格检查测试（2项研究）和磁共振成像（MRI）（4项研究）的诊断性能。大多数研究（97%）被评估为存在“不清楚”或“高风险”偏倚。超声弹性成像显示出最高的敏感性（75%-100%）和特异性（85%-96%）。有或没有多普勒的灰阶USI表现出从差到优的值（敏感性：53%-100%，特异性：42%-90%）。MRI在肌腱增厚和附着点病的诊断中表现更好（敏感性和特异性：81%-100%）。Cozen试验报告了高敏感性（91%），而肘屈伸之间握力差异5%-10%显示出高敏感性（78%-83%）和特异性（80%-90%）。
Cozen试验和握力测量在LET诊断中具有较高准确性，但研究较少。USI和MRI根据报告的实体提供不同的诊断准确性，在需要进行鉴别诊断时应谨慎推荐。在纳入标准、操作者/检查者、应用方式、设备类型和参考标准方面，各研究之间存在很大异质性。
PROSPERO编号CRD42020160402。
