Study on the Diagnostic Value of Physical Examination and Magnetic Resonance Imaging in Subscapularis Muscle Tear
Objective ①To compare the diagnostic value of single shoulder joint physical examination and magnetic resonance imaging(MRI)in subscapular tendon tear;(2)To explore the diagnostic value of combined physical examination for subscapular tendon tear.Methods A total of 125 patients who underwent arthroscopic shoulder surgery in the Department of Joint Surgery,the First Affiliated Hospital of Shihezi University from August 2021 to December 2022 were prospectively collected.The arthroscopic diagnosis was used as the gold standard.All patients underwent standardized shoulder joint physical examination and 3.0 T MRI examination before surgery.The clinical tests included Lift Off Test(LOT),Belly Press Test(BPT),Bear Hug Test(BHT),Napoleon Test,Belly Off Sign(BOS),Internal Rotation Lag Sign(IRLS),Internal Rotation Resistance Test at 0° Abduction and 0° External Rotation(IRRT0°)and Internal Rotation Resistance Test at Maximum 90° Abduction and Maximum External Rotation(IRRTM).Kappa test was used to compare the inter-observer differences of clinical tests,and the sensitivity,specificity,Youden's index,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,and diagnostic odds ratio were calculated.Draw the receiver operating characteristics(ROC)curves and calculate the areas under the curve(AUC)to compare the diagnostic values of clinical tests and 3.0T MRI.The four clinical tests with the highest AUC values were selected,and the sensitivity,specificity,Youden's index and AUC of serial and parallel diagnosis of two,three and four clinical tests were calculated to compare the diagnostic values between the combined clinical tests.Finally,the combined clinical test with the best diagnostic efficacy was selected and compared with MRI.Results The sensitivity of single physical examination in the diagnosis of subscapular tendon tear was less than 70％,and the specificity was more than 80％.The sensitivity of IRRTM,LOT,Napoleon,BPT,IRLS,BOS,IRRT0° and BHT were 61.29％,35.48％,29.03％,35.48％,25.81％,58.06％,51.61％and 58.06％,respectively.The eight physical examinations were ranked from high to low according to AUC values:IRRTM(0.748),BOS(0.716),BHT(0.700),IRRT0°(0.689),LOT(0.608),BPT(0.603),Napoleon(0.587),IRLS(0.571);the sensitivity,specificity and AUC of MRI in the diagnosis of subscapular tendon tear were 77.42％,84.04％and 0.807,respectively.②IRRTM,BOS,BHT,and IRRT0° were selected for series-parallel diagnostic tests,the results showed that the diagnostic sensitivities of series IRRTM+BOS,IRRTM+BOS+BHT,and IRRTM+BOS+BHT+IRRT0° were 35.48％,16.13％,and 9.68％,respectively;the specificities were 97.87％,100.00％,and 100.00％,respectively;the Youden indexes were 0.301,0.161,and 0.097,respectively;the AUC values were 0.683,0.613 and 0.548,respectively.The diagnostic sensitivities of parallel IRRTM+BOS,IRRTM+BOS+BHT and IRRTM+BOS+BHT+IRRT0° were 83.87％,96.77％and 100.00％,respectively;the specificity was 77.66％,64.89％and 60.64％,respectively;the Youden index was 0.615,0.617 and 0.606,respectively;the AUC values were 0.749,0.749,and 0.798,respectively.③The AUC values of parallel IRRTM+BOS+BHT+IRRT0° and MRI were 0.798 and 0.807,respectively,but there was no significant difference in AUC between the two groups(P＞0.05).Conclusion ①The value of single physical examination in the diagnosis of subscapular tendon tear is limited,and MRI shows better diagnostic efficacy than single physical examination.(2)Combined physical examination is helpful to improve the diagnostic value of subscapular tendon tear.Among them,parallel IRRTM+BOS+BHT+IRRT0° has the highest diagnostic value for subscapular tendon tear.The diagnostic value of parallel IRRTM+BOS+BHT+IRRT0° is similar to that of MRI.
Subscapularis tendon tearPhysical examinationMagnetic resonance imagingDiagnostic testCombined test
万方数据
维普
