Boble Maxime, Charousset Christophe, Samargandi Ramy, Dordain Franck, Gadéa François, Gallinet David, Barth Johannes, Guery Jacques, Bonnevialle Nicolas, Jacquot Adrien, Berhouet Julien
Université de Tours - Faculté de Médecine de Tours - CHRU Tours, Hôpital Trousseau, Service d'Orthopédie Traumatologie, Tours, France.
Institut Ostéo Articulaire Paris Courcelles, Paris, France.
J Shoulder Elbow Surg. 2025 Aug;34(8):1949-1960. doi: 10.1016/j.jse.2024.11.032. Epub 2025 Jan 20.
The purpose of this study was to determine the clinical value of diagnostic tests for the long head of the biceps tendon (LHBT) injuries in the setting of a Patte stage 1 supraspinatus tendon rupture.
This was a prospective cohort multicenter study of 361 patients aged 30-80 years with Patte stage 1 distal supraspinatus tendon rupture. The LHBT was assessed clinically by palpation of the bicipital groove, the Speed test, the Yergason test and the Kibler test. Under arthroscopy, a rigorous static and dynamic analysis of the long head of the biceps tendon was performed in order to define its pathologic character, or healthy character, without or with so-called minor injuries. The anterior extension of the supraspinatus tendon rupture was also analyzed, especially with Jobe test.
The Speed test had the highest sensitivity (74.5%) for diagnosing pathologic biceps. When combined with palpation of the bicipital groove, the sensitivity increased to 85%. The Kibler test had the highest specificity (74.7%). Combined in series with the Yergason test, the specificity increased to 87.2%. In case of anterior extension of the supraspinatus tendon rupture and to demonstrate an LHBT lesion, the Kibler test had the highest post-test probabilities with a positive likelihood ratio of 2.030 for pathological LHBT and 1852 for minor injuries of LHBT. The pathologic biceps group had a significantly higher mean age (P < .0001), BMI (P = .018), diabetes prevalence (P = .009), and proportion of supraspinatus tendon lesions with anterior extension (P < .0001) CONCLUSIONS: The Kibler test is the most efficient test for the diagnosis of LHBT lesions. Its combination with palpation of the bicipital groove increases its clinical value in the pathologic group. The anterior extension of a lesion of the supraspinatus tendon may nevertheless make these tests positive, even though the LHBT is macroscopically healthy. Older age, overweight, and diabetes should be major predictors of LHBT injury.
本研究的目的是确定在帕泰1期冈上肌腱断裂情况下，诊断肱二头肌长头（LHBT）损伤的诊断试验的临床价值。
这是一项对361例年龄在30 - 80岁的帕泰1期冈上肌腱远端断裂患者进行的前瞻性队列多中心研究。通过触诊肱二头肌沟、斯皮德试验、耶尔加森试验和基布勒试验对LHBT进行临床评估。在关节镜检查下，对肱二头肌长头进行严格的静态和动态分析，以确定其病理特征或健康特征，有无所谓的轻微损伤。还分析了冈上肌腱断裂的前延伸情况，特别是通过乔布试验。
斯皮德试验对诊断病理性肱二头肌的敏感性最高（74.5%）。与肱二头肌沟触诊相结合时，敏感性提高到85%。基布勒试验的特异性最高（74.7%）。与耶尔加森试验串联使用时，特异性提高到87.2%。在冈上肌腱断裂有前延伸且要证明存在LHBT损伤的情况下，基布勒试验具有最高的验后概率，病理性LHBT的阳性似然比为2.030，LHBT轻微损伤的阳性似然比为1852。病理性肱二头肌组的平均年龄（P < .0001）、体重指数（P = .018）、糖尿病患病率（P = .009）以及冈上肌腱损伤有前延伸的比例（P < .0001）均显著更高。
基布勒试验是诊断LHBT损伤最有效的试验。它与肱二头肌沟触诊相结合可提高其在病理组中的临床价值。然而，冈上肌腱损伤的前延伸可能会使这些试验呈阳性，即使LHBT在宏观上是健康的。年龄较大、超重和糖尿病应是LHBT损伤的主要预测因素。
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