Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations

Abstract

We describe the biceps load test for evaluating the integrity of the superior glenoid labrum in shoulders with recurrent anterior dislocations. With the shoulder in an abducted, externally rotated position and the forearm supinated, active flexion of the elbow against resistance relieves the discomfort of a standard apprehension test for anterior shoulder instability. A group of 75 patients with proven unilateral anterior shoulder dislocations were prospectively examined in a double-blind fashion with arthroscopic examination and the biceps load test. Sixty-three patients had a negative test and 62 of these had an intact biceps tendon-superior labrum complex; the remaining patient had a type II superior labral anterior and posterior lesion. Twelve patients had positive tests, and 10 had superior labral lesions; the other 2 patients had intact superior labra. Therefore, the biceps load test revealed a sensitivity of 90.9%, a specificity of 96.9%, a positive predictive value of 83%, a negative predictive value of 98%, and a kappa coefficient of 0.846.