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The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study

BACKGROUND: Several physical examination tests and signs have been described to aid in the diagnosis of subscapularis (SSC) tear, but have limitations and variable sensitivity. This study aimed to introduce a novel test for detecting a leading-edge tear of the subscapularis (LETS), the most importan...

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Autores principales: Rhee, Sung-Min, Youn, Seung-Min, Park, Joon Hong, Chang, Geun Wu, Rhee, Yong Girl
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288008/
https://www.ncbi.nlm.nih.gov/pubmed/35842588
http://dx.doi.org/10.1186/s12891-022-05621-1
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author Rhee, Sung-Min
Youn, Seung-Min
Park, Joon Hong
Chang, Geun Wu
Rhee, Yong Girl
author_facet Rhee, Sung-Min
Youn, Seung-Min
Park, Joon Hong
Chang, Geun Wu
Rhee, Yong Girl
author_sort Rhee, Sung-Min
collection PubMed
description BACKGROUND: Several physical examination tests and signs have been described to aid in the diagnosis of subscapularis (SSC) tear, but have limitations and variable sensitivity. This study aimed to introduce a novel test for detecting a leading-edge tear of the subscapularis (LETS), the most important tendinous portion of SSC. METHODS: A total of 233 patients who underwent arthroscopic repair for anterior and superior cuff tears between January 2018 to September 2019 were retrospectively reviewed. The provocative test we have coined as the “scissors sign” and the other related clinical tests (i.e., belly press, belly off, Napoleon, lift off, internal rotation lag, bear hug tests) were performed preoperatively. Whether the patient has a LETS or the complete tear of the SSC (CTS) was confirmed by arthroscopic findings. Sensitivity, specificity, and areas under the receiver operating characteristic curve were calculated for each test. RESULTS: In patients who had LETS with or without supraspinatus tear, the scissors sign showed the highest sensitivity (91.4%) with a specificity of 81.6%, positive predictive value (PPV) of 80.2%, and negative predictive value (NPV) of 92.1%. In patients with isolated LETS, the scissors sign also showed the highest sensitivity (90.3%) with a specificity of 81.6%, PPV of 57.1%, and NPV of 96.8%. The scissors sign for the complete tear of the subscapularis (CTS) with or without supraspinatus tear and the isolated CTS had a sensitivity of 73.1 and 75%, respectively. CONCLUSIONS: The scissors sign is a novel provocative test that can be helpful in the diagnosis of subscapularis tears, especially LETS, with its high sensitivity and diagnostic accuracy. In combination with other tests, the scissors sign will be a good screening tool. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05621-1.
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spelling pubmed-92880082022-07-17 The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study Rhee, Sung-Min Youn, Seung-Min Park, Joon Hong Chang, Geun Wu Rhee, Yong Girl BMC Musculoskelet Disord Research Article BACKGROUND: Several physical examination tests and signs have been described to aid in the diagnosis of subscapularis (SSC) tear, but have limitations and variable sensitivity. This study aimed to introduce a novel test for detecting a leading-edge tear of the subscapularis (LETS), the most important tendinous portion of SSC. METHODS: A total of 233 patients who underwent arthroscopic repair for anterior and superior cuff tears between January 2018 to September 2019 were retrospectively reviewed. The provocative test we have coined as the “scissors sign” and the other related clinical tests (i.e., belly press, belly off, Napoleon, lift off, internal rotation lag, bear hug tests) were performed preoperatively. Whether the patient has a LETS or the complete tear of the SSC (CTS) was confirmed by arthroscopic findings. Sensitivity, specificity, and areas under the receiver operating characteristic curve were calculated for each test. RESULTS: In patients who had LETS with or without supraspinatus tear, the scissors sign showed the highest sensitivity (91.4%) with a specificity of 81.6%, positive predictive value (PPV) of 80.2%, and negative predictive value (NPV) of 92.1%. In patients with isolated LETS, the scissors sign also showed the highest sensitivity (90.3%) with a specificity of 81.6%, PPV of 57.1%, and NPV of 96.8%. The scissors sign for the complete tear of the subscapularis (CTS) with or without supraspinatus tear and the isolated CTS had a sensitivity of 73.1 and 75%, respectively. CONCLUSIONS: The scissors sign is a novel provocative test that can be helpful in the diagnosis of subscapularis tears, especially LETS, with its high sensitivity and diagnostic accuracy. In combination with other tests, the scissors sign will be a good screening tool. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05621-1. BioMed Central 2022-07-16 /pmc/articles/PMC9288008/ /pubmed/35842588 http://dx.doi.org/10.1186/s12891-022-05621-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Rhee, Sung-Min
Youn, Seung-Min
Park, Joon Hong
Chang, Geun Wu
Rhee, Yong Girl
The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
title The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
title_full The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
title_fullStr The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
title_full_unstemmed The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
title_short The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
title_sort scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288008/
https://www.ncbi.nlm.nih.gov/pubmed/35842588
http://dx.doi.org/10.1186/s12891-022-05621-1
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