title: Accuracy of long head of the biceps subluxation as a predictor for subscapularis tears.
abstract: OBJECTIVE
  The aim of this study is to understand the relation between long head of the biceps tendon (LHBT) subluxation and full-thickness tears of the subscapularis.
  
  
  METHODS
  Magnetic resonance imaging (MRI) scans of 94 patients undergoing shoulder arthroscopy were evaluated preoperatively for the presence or absence of LHBT subluxation. Intraoperative pathology of the biceps and subscapularis tendons was recorded. The diagnostic accuracy of LHBT subluxation on preoperative MRI in determining full-thickness subscapularis tendon tears was calculated.
  
  
  RESULTS
  Of the 94 patients in this study, 26 were diagnosed with LHBT subluxation preoperatively. Of these 26 patients, 9 were confirmed to have full-thickness tears of the subscapularis tendon (Lafosse grade 2 or higher). Of the remaining 68 patients who did not appear to have LHBT subluxation preoperatively, 2 were confirmed to have full-thickness tears of the subscapularis tendon. Thus LHBT subluxation on MRI as a predictor for full-thickness subscapularis tears had a sensitivity of 82%, specificity of 80%, positive predictive value of 35%, and negative predictive value of 97%. LHBT subluxation was directly correlated with the severity of the subscapularis tendon tear (P < .001).
  
  
  CONCLUSIONS
  The diagnostic value of subluxation of the LHBT, as seen on an axial MRI scan, lies primarily in its negative predictive value. If the LHBT is not subluxated, it is unlikely that a full-thickness tear of the subscapularis tendon is present. Surgeons should be cautious about relying on biceps subluxation as a primary diagnostic tool in predicting subscapularis tears.
  
  
  METHODS
  Level IV, study of diagnostic test.
authors: Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Chicago, Illinois, U.S.A.
authors: Lewis L
authors: LL
authors: Shi
authors: Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Chicago, Illinois, U.S.A.
authors: Martin G
authors: MG
authors: Mullen
authors: Department of Orthopaedic Surgery, Division of Sports Medicine and Shoulder Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A.
authors: Michael T
authors: MT
authors: Freehill
authors: Division of Shoulder Surgery and Sports Medicine, University of Pittsburgh, UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A.
authors: Albert
authors: A
authors: Lin
authors: Harvard Shoulder Service, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
authors: Jon J P
authors: JJ
authors: Warner
authors: Sports Medicine and the Shoulder Service, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.. Electronic address: ldhiggins@partners.org.
authors: Laurence D
authors: LD
authors: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006801:Humans; D022125:Lacerations / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000175:diagnosis; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D013708:Tendon Injuries / Q000175:diagnosis* / Q000601:surgery; D013710:Tendons / Q000601:surgery; D055815:Young Adult