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Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

2001; BMJ; Volume: 35; Issue: 1 Linguagem: Inglês

10.1136/bjsm.35.1.65

1473-0480

J L Cook, K M Khan, Z S Kiss, Craig Purdam, Lyn R. Griffiths,

Shoulder Injury and Treatment

Background —Palpation is an important clinical test for jumper's knee. Objectives —To ( a ) test the reproducibility of palpation tenderness, ( b ) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and ( c ) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. Methods —In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. Results —Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01). Conclusions —In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.