La exactitud de la rapidez y el test de Yergason en la detección de la patología de biceps y las lesiones SLAP: Comparación con los hallazgos de la artroscopia.
Richard Holtby, M.B., B.S.* a [MEDLINE LOOKUP] Helen Razmjou, B.Sc.(P.T.), M.Sc., Cred. M.D.T.a [MEDLINE LOOKUP]
Purpose The purpose of this study was to explore and describe reasons for variation in diagnostic accuracy of clinical tests using Yergasons and Speeds tests in predicting biceps tendon pathology and SLAP lesions. Shoulder arthroscopy was used as the gold standard.
Type of study Prospective blinded study of consecutive patients with a wide spectrum of shoulder conditions.
Methods One hundred fifty-two subjects (65 women and 87 men) with complaints of shoulder pain were examined. Fifty subjects (16 women and 34 men) ranging in age from 24 to 79 years (mean age, 50 years; SD = 14.36) met the criteria for surgery. The validity of the Yergasons and Speeds tests was evaluated against findings at surgery.
Results The surgical findings related to biceps pathology and SLAP lesions were as follows: 2 bicipital tendonitis, both associated with significant rotator cuff pathology; 10 biceps partial tears; and 2 complete ruptures. Fifteen patients had SLAP lesion type I, 12 type II, and 1 type IV. The sensitivity, specificity, and positive and negative predictive values were 43%, 79%, 60%, and 65% for Yergasons test and 32%, 75%, 50%, and 58% for Speeds test, respectively. The likelihood ratios were 1.28 and 0.91 for Speeds test and 2.05 and 0.72 for Yergasons test. These ratios were provided to assist clinicians in calculating the probability of biceps pathology and SLAP lesions for a single patient with a different history-specific prevalence of having the pathology.
Conclusions Although Speeds and Yergasons tests are moderately specific, they do not generate a large change in the post-test probability and are unlikely to make a significant change in the pretest diagnosis. Clinicians should understand that clinical examination tests do not perform consistently and have variable predictive values in different patient populations and settings.
Level of evidence Level I diagnostic study: testing of previously developed criteria in a series of consecutive patients (using surgery as gold standard).