Correlation between clinical, ultrasonographic and arthroscopic findings of subscapularis tears: A prospective study

Background: Preoperative clinical and ultrasonographic (USG) diagnosis of subscapularis (SSc) tear has always been challenging, with studies reporting varying diagnostic values of these modalities compared with arthroscopy. This prospective study aimed to report the diagnostic values of clinical tests and ultrasonography for SSc tear and to correlate with respect to arthroscopy. Methodology: Clinical and USG data were collected preoperatively from 144 patients who underwent arthroscopy for rotator cuff tears. Lafosse's classification was used for classifying SSc tear. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy with receiver operating curve (ROC) of clinical tests and USG were statistically analyzed and compared with arthroscopic findings. Results: Among 144 patients, 70 % had subscapularis tear. Gerber's lift-off was the most sensitive and accurate in diagnosing partial thickness tear (72.1 %, 63.3 %) and overall any tear (77.4 %, 76.7 %). Belly-off was the most specific test in detecting partial-thickness tear (61.5 %) and any tear (88.9 %). Bear hug test (BHT) was the most specific (65.9 %) and accurate (69.8 %) for diagnosing a full-thickness tear. ROC analysis showed maximum accuracy with the belly-off for full-thickness tears and Gerber's lift-off for partial-thickness tears. Compared to clinical tests, USG has lower accuracy in detecting partial tears and higher accuracy (81.7 %) for complete tears. Conclusion: The diagnostic performance of all modalities for detecting any tear is ranked as follows: Gerber's Lift-Off, Belly Press, Passive Lift-Off, USG, Belly-Off, and BHT. Results of partial tears were similar. For full-thickness tears: USG, Belly-Off, BHT, Passive Lift-Off, Belly press and Gerber's Lift-Off. Level of study: Level III, Prospective.