Nair Arvind, Reddy Bishak S, Sait Anika, Ps Priya, Pandey Vivek
Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.
Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India.
J Orthop. 2025 Apr 28;64:176-181. doi: 10.1016/j.jor.2025.04.016. eCollection 2025 Jun.
Preoperative clinical and ultrasonographic (USG) diagnosis of subscapularis (SSc) tear has always been challenging, with studies reporting varying diagnostic values of these modalities compared with arthroscopy. This prospective study aimed to report the diagnostic values of clinical tests and ultrasonography for SSc tear and to correlate with respect to arthroscopy.
Clinical and USG data were collected preoperatively from 144 patients who underwent arthroscopy for rotator cuff tears. Lafosse's classification was used for classifying SSc tear. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy with receiver operating curve (ROC) of clinical tests and USG were statistically analyzed and compared with arthroscopic findings.
Among 144 patients, 70 % had subscapularis tear. Gerber's lift-off was the most sensitive and accurate in diagnosing partial thickness tear (72.1 %, 63.3 %) and overall any tear (77.4 %, 76.7 %). Belly-off was the most specific test in detecting partial-thickness tear (61.5 %) and any tear (88.9 %). Bear hug test (BHT) was the most specific (65.9 %) and accurate (69.8 %) for diagnosing a full-thickness tear. ROC analysis showed maximum accuracy with the belly-off for full-thickness tears and Gerber's lift-off for partial-thickness tears. Compared to clinical tests, USG has lower accuracy in detecting partial tears and higher accuracy (81.7 %) for complete tears.
The diagnostic performance of all modalities for detecting any tear is ranked as follows: Gerber's Lift-Off, Belly Press, Passive Lift-Off, USG, Belly-Off, and BHT. Results of partial tears were similar. For full-thickness tears: USG, Belly-Off, BHT, Passive Lift-Off, Belly press and Gerber's Lift-Off.
Level III, Prospective.
肩胛下肌（SSc）撕裂的术前临床及超声（USG）诊断一直具有挑战性，与关节镜检查相比，不同研究报道了这些检查方式的不同诊断价值。本前瞻性研究旨在报告临床检查及超声对SSc撕裂的诊断价值，并与关节镜检查结果进行相关性分析。
术前收集了144例因肩袖撕裂接受关节镜检查患者的临床及USG数据。采用Lafosse分类法对SSc撕裂进行分类。对临床检查及USG的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）以及采用受试者工作特征曲线（ROC）分析的准确性进行统计学分析，并与关节镜检查结果进行比较。
144例患者中，70%存在肩胛下肌撕裂。Gerber抬离试验在诊断部分厚度撕裂（72.1%，63.3%）及总体任何撕裂（77.4%，76.7%）方面最为敏感和准确。腹部按压试验是检测部分厚度撕裂（61.5%）及任何撕裂（88.9%）最具特异性的检查。熊抱试验（BHT）在诊断全层撕裂方面最具特异性（65.9%）和准确性（69.8%）。ROC分析显示，腹部按压试验对全层撕裂的准确性最高，Gerber抬离试验对部分厚度撕裂的准确性最高。与临床检查相比，USG在检测部分撕裂时准确性较低，而在检测完全撕裂时准确性较高（81.7%）。
各种检查方式对检测任何撕裂的诊断性能排序如下：Gerber抬离试验、腹部按压试验、被动抬离试验、USG、腹部按压试验、BHT。部分撕裂的结果相似。对于全层撕裂：USG、腹部按压试验、BHT、被动抬离试验、腹部按压试验和Gerber抬离试验。
III级，前瞻性研究。
