Article

OBJECTIVE: To determine the accuracy of palpating the long head of the biceps
tendon (LHBT) within the intertubercular groove with the use of ultrasonographic
localization as a gold standard. DESIGN: Prospective, single-blinded pilot study.
SETTING: Sports medicine clinic at a tertiary care academic institution.
PARTICIPANTS: Twenty-five male and female asymptomatic volunteers ages 24-41
years (mean, 30.9 +/- 4.3 years) with body mass indices of 19.3 to 36.3 kg/m(2)
(23.84 +/- 4.8 kg/m(2)). METHODS: Three examiners of differing experience (a
sports medicine board-certified staff physician, a sports medicine fellow, and a
physical medicine and rehabilitation resident) identified the LHBT location in
the intertubercular groove via palpation on a subject in the supine position and
marked its location by taping an 18-gauge Tuohy needle to the skin overlying the
groove. The examiner order was randomized. A fourth examiner who was blinded to
the palpation order assessed the previous examiner's palpation accuracy by
comparing the needle position to the sonographically determined tendon position.
MAIN OUTCOME MEASURES: Needle placement in relation to the intertubercular groove
was graded as being within the groove, medial to the groove, or lateral to the
groove. In the latter 2 cases, the distance from the needle to the closest groove
edge was recorded. RESULTS: Overall accuracy rate was 5.3% (4/75), ranging from
0% (0/25) for the resident to 12% (3/25) for the fellow
(P </= .007 for
interexaminer differences). All missed palpations were localized medial to the
intertubercular groove by an average of 1.4 +/- 0.5 cm (range, 0.3 for the fellow
to 3.5 cm for the resident). CONCLUSION: Based on the current methodology,
clinicians have a tendency to localize the intertubercular groove medial to its
actual location. Consequently, clinicians should exercise caution when relying on
clinical palpation to either diagnose a biceps tendon disorder or perform a
bicipital tendon sheath injection. When clinically indicated, sonographic
guidance can be used to accurately identify the LBHT within the intertubercular
groove.
CI - Copyright (c) 2011 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS