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Diagnostic value of the hourglass biceps test for the detection of intra-articular long head of the biceps hypertrophy

Baumann Q, Hue A-G, Lutz P, Hardy A, Mertl P, Courage O

JSES International 2020 Dec;4(4):906-912

primary study

BACKGROUND: Shoulder surgeons performing tenodesis note a great variability in morphology of the proximal biceps. The hourglass biceps test measures the integrity of the intra-articular biceps tendon. The hourglass maneuver (HM) is positive when there is a passive flexion deficit compared to the contralateral shoulder in a relaxed patient in the supine position. HYPOTHESIS: Preoperative HM is correlated with an increased width of the biceps portion resected during tenodesis. METHODS: This prospective study evaluated all patients (N = 58) who underwent biceps tenodesis between January and September 2019. Two groups of patients were compared: group 1 (n = 20) had a positive HM and group 2 had a negative HM (n = 38). The smallest (S) and largest (L) width of the tendon were measured intraoperatively, and the L/S ratio was calculated. The HM was then evaluated as a diagnostic test by creating a contingency table and determining the sensitivity and specificity of the test for different L/S ratios. A receiver operating characteristic curve was created and the area under the curve (AUC) was calculated. RESULTS: A nonsignificant difference was found between the mean largest biceps width in group 1 compared to group 2 (11.65 mm (range 5 to 21) versus 9.71 mm (range 6 to 20), respectively; p < 0.05). The AUC was 0.81; the sensitivity was 68.9% and specificity, 80.8%. CONCLUSION: Preoperative positivity of the HM is linked to the increased width of the biceps portion resected during tenodesis. The hourglass biceps test should be predictive of intraoperative hourglass biceps according to our definition.

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