Diagnostic Values Of Clinical Tests With Magnetic Resonance Imaging In Subscapularis Tendon Tears

Objective:(1)To compare the diagnostic values of clinical tests and magnetic resonance imaging(MRI)in subscapularis(SSC)tendon tears;(2)To compare the diagnostic values of combined clinical tests in SSC tendon tears.Methods: From August 2021 to December 2022,125 patients who underwent shoulder arthroscopic surgery in Joint Surgery Center of the First Affiliated Hospital of Shihezi University were prospectively collected and divided into subscapularis tendon tear group(31 cases)and non-tear group(94 cases)according to the arthroscopic diagnosis.All patients underwent standardized clinical tests of shoulder joint and 3.0T MRI 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:(1)The diagnostic specificity of eight clinical tests were all more than 80% whereas sensitivity were all less than 70%.The diagnostic 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 8clinical tests are listed in descending order of AUC: IRRTM(0.748),BOS(0.716),BHT(0.700),IRRT0°(0.689),LOT(0.608),BPT(0.603),Napoleon(0.587),and IRLS(0.571).The sensitivity,specificity and AUC of MRI were 77.42%,84.04% and 0.807,respectively.(2)Series and parallel diagnostic tests were performed on IRRTM,BOS,BHT and IRRT0°.The diagnostic sensitivity and specificity of series IRRTM+BOS,IRRTM+BOS+BHT and IRRTM+BOS+BHT+IRRT0° were 35.48%,16.13% and 9.68%,and97.87%,100% and 100%,respectively.Youden’s index was 0.301,0.161 and 0.097,respectively.The values of AUC were 0.683,0.613 and 0.548,respectively.The diagnostic sensitivity of parallel IRRTM+BOS,IRRTM+BOS+BHT and IRRTM+BOS+BHT+IRRT0° were 83.87%,96.77% and 100%,respectively.The specificity was 77.66%,64.89%,60.64%,and Youden’s index was 0.615,0.617,0.606,respectively.The values of AUC were 0.749,0.749 and 0.798,respectively.(3)The values of AUC for parallel IRRTM+BOS+BHT+IRRT0° and MRI were 0.798 and 0.807,respectively.Comparing the AUCs of the two,the difference was not statistically significant(P > 0.05).Conclusions:(1)The diagnostic values of every single clinical test for subscapularis tendon tear was limited and MRI showed better diagnostic efficacy than single clinical test.(2)Combined clinical tests was helpful to improve the diagnostic value of SSC tears.The parallel use of IRRTM+BOS+BHT+IRRT0° had the highest diagnostic value.(3)The parallel use of IRRTM+BOS+BHT+IRRT0° showed similar diagnostic value compared to MRI.