Physical examination tests are not valid for diagnosing SLAP tears: a review

Abstract

Objective: To critically evaluate the evidence for the use of physical examination procedures for diagnosing superior labrum anterior posterior (SLAP) lesions, by means of a systematic review.

Data sources: MEDLINE, EMBASE, and The Cochrane data bases were searched for studies published between January 1970 and June 2004, in 3 stages, using SLAP lesion; arthroscopy, shoulder joint and athletic injuries combined with testing and physical examination; and arthroscopy, shoulder joint and athletic injuries combined with sensitivity and specificity (total yield, 260 articles). Additional studies were sought in the reference lists of relevant articles.

Study selection: Potentially relevant abstracts were selected from the 3 search strategies. Studies were included if they focused on physical examination of SLAP lesions and presented original data on the accuracy of the test. Of 29 potentially relevant studies, 15 were selected when the full text was reviewed.

Data extraction: Information on the number of participants, the study design, the physical test(s) evaluated, and the sensitivity, specificity, and positive and negative predictive value of the tests were extracted or calculated. Study validity was evaluated (1-5 points: independent, blind comparison with a reference standard; inclusion of an appropriate spectrum of patients; all participants were assessed by the reference standard; replicable description of the test; and likelihood ratios presented or calculable).

Main results: The physical tests included from 1 to 6 of the anterior slide test, SLAPprehension test, biceps load tests, crank test, O'Brien test, active compression, compression rotation, Speed's test, Yergason's test, Jobe test, bicippital groove pain, and pain provocation. The only study that passed all 5 methods criteria found that Speed's test and Yergason's test had sensitivity of 32% and 43%, and specificity of 79% and 75%, respectively; thus, the positive and negative likelihood ratios for Speed's test were 1.2727 and 0.9091 and for Yergason's test were 2.000 and 0.7272. The confidence intervals for the likelihood ratios all included 1.0. Whereas the test descriptions in the other reports were generally clear, only 7 of the other 14 studies passed 1 further methods criterion. Nine of these studies reported sensitivities and specificities for the physical tests of >75%.

Conclusion: The accuracy of Speed's and Yergason's tests for diagnosing a SLAP lesion was poor in the only methodologically robust study reviewed. The likelihood ratios for these tests could not rule in, or rule out, the presence of a SLAP lesion when compared with arthroscopic results. Assessments of numerous other tests could not be considered valid because of the serious shortcomings in the studies' methods.