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Studies that compared the diagnostic accuracy of clinical tests or ultrasound versus arthroscopy for the assessment of LHBT pathologies were included.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven studies were included reporting on a total of 448 patients. One study on instability using ultrasound reported sensitivity and specificity of 1.00 and 0.96, respectively. Two studies on full\u2010thickness tears using ultrasound reported sensitivity and specificity of 0.88\u20130.95 and 0.71\u20130.98, respectively. Four studies on partial\u2010thickness LHBT tears reported sensitivity and specificity of 0.17\u20130.68 and 0.38\u20130.92, respectively, for clinical tests, versus 0.27\u20130.71 and 0.71\u20131.00, respectively, for ultrasound. Three studies on other LHBT pathologies reported sensitivity and specificity of 0.18\u20130.79 and 0.53\u20130.85, respectively, for clinical tests, versus 0.50 and 1.00, respectively, for ultrasound.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>To detect LHBT pathologies, sensitivity is high\u2010to\u2010excellent using ultrasound, and moderate using Neer\u2019s sign and Speed\u2019s test, while specificity is high\u2010to\u2010excellent also using ultrasound, as well as the belly press, lift\u2010off and Kibler\u2019s tests. The clinical relevance of these findings is that clinical tests are only reliable either to confirm or rule out LHBT pathologies, whereas ultrasound is reliable both to confirm and rule out LHBT pathologies. While diagnostic imaging cannot substitute for patient history and physical examination, the reliability and accessibility of ultrasound render it practical for routine use, particularly if clinical tests render unclear or contradictory findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-07154-5","type":"journal-article","created":{"date-parts":[[2022,9,17]],"date-time":"2022-09-17T06:02:36Z","timestamp":1663394556000},"page":"662-671","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Ultrasound is more reliable than clinical tests to both confirm and rule out pathologies of the long head of the biceps: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"31","author":[{"given":"Olivier","family":"Courage","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Ramsay 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