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Diagnostic accuracy of clinical tests for subscapularis tears: a systematic review and meta-analysis

Ladermann A, Collin P, Zbinden O, Meynard T, Saffarini M, Chiu JC-H

Orthopaedic Journal of Sports Medicine 2021 Sep;9(9):23259671211042011

systematic review

BACKGROUND: Previous systematic reviews and meta-analyses on the diagnostic accuracy of shoulder clinical tests do not reach conclusions regarding subscapularis tears. PURPOSE: To compare the diagnostic accuracy of commonly used clinical tests for subscapularis tears. STUDY DESIGN: Systematic review; level of evidence, 3. METHODS: An electronic literature search was conducted using Medline, Embase, and the Cochrane Library/CENTRAL. Eligibility criteria were original clinical studies reporting the diagnostic accuracy of clinical tests to diagnose the presence of rotator cuff tears involving the subscapularis. RESULTS: The electronic literature search returned 2,212 records, of which 13 articles were eligible. Among 8 tests included in the systematic review, the Lift-Off Test was most frequently reported (12 studies). Four tests were eligible for meta-analysis: Bear-Hug Test, Belly-Press Test, Internal Rotation Lag Sign (IRLS), and Lift-Off Test. The highest pooled sensitivity was 0.55 (95% CI 0.28 to 0.79) for the Bear-Hug Test, while the lowest pooled sensitivity was 0.32 (95% CI 0.13 to 0.61), for the IRLS. In all tests, pooled specificity was > 0.90. CONCLUSION: Among the 4 clinical tests eligible for meta-analysis (Bear-Hug Test, Belly-Press Test, IRLS, and lift-off test), all had pooled specificity > 0.90 but pooled sensitivity < 0.60. No single clinical test is sufficiently reliable to diagnose subscapularis tears. REGISTRATION: PROSPERO CRD42019137019.

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