Purpose: The purpose of this study was to explore and describe reasons for variation in diagnostic accuracy of clinical tests using Yergason's and Speed's tests in predicting biceps tendon pathology and SLAP lesions. Shoulder arthroscopy was used as the gold standard.
Type of study: Prospective blinded study of consecutive patients with a wide spectrum of shoulder conditions.
Methods: One hundred fifty-two subjects (65 women and 87 men) with complaints of shoulder pain were examined. Fifty subjects (16 women and 34 men) ranging in age from 24 to 79 years (mean age, 50 years; SD = 14.36) met the criteria for surgery. The validity of the Yergason's and Speed's tests was evaluated against findings at surgery.
Results: The surgical findings related to biceps pathology and SLAP lesions were as follows: 2 bicipital tendonitis, both associated with significant rotator cuff pathology; 10 biceps partial tears; and 2 complete ruptures. Fifteen patients had SLAP lesion type I, 12 type II, and 1 type IV. The sensitivity, specificity, and positive and negative predictive values were 43%, 79%, 60%, and 65% for Yergason's test and 32%, 75%, 50%, and 58% for Speed's test, respectively. The likelihood ratios were 1.28 and 0.91 for Speed's test and 2.05 and 0.72 for Yergason's test. These ratios were provided to assist clinicians in calculating the probability of biceps pathology and SLAP lesions for a single patient with a different history-specific prevalence of having the pathology.
Conclusions: Although Speed's and Yergason's tests are moderately specific, they do not generate a large change in the post-test probability and are unlikely to make a significant change in the pretest diagnosis. Clinicians should understand that clinical examination tests do not perform consistently and have variable predictive values in different patient populations and settings.
Level of evidence: Level I diagnostic study: testing of previously developed criteria in a series of consecutive patients (using surgery as gold standard).