Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct 5;3(4):e154-e162.
doi: 10.1055/s-0037-1606829. eCollection 2017 Oct.

Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions

Lyndsay E Somerville  1 , Kevin Willits  1 , Andrew M Johnson  2 , Robert Litchfield  1 , Marie-Eve LeBel  1 , Jaydeep Moro  3 , Dianne Bryant  1   2   4
Affiliations

Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions

Lyndsay E Somerville et al. Surg J (N Y). .

Abstract

Purpose Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study. Methods We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis ("certain the diagnosis is absent/present," or "uncertain requires further testing"). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions. Results Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I-V) as disease positive, none of the tests was sensitive (10.3-33.3) although they were moderately specific (61.3-92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5-38.7) and specificity (70.6-93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and specificity 64.7%). Conclusion Our study demonstrates that the physical examination tests for SLAP lesions are poor diagnostic indicators of disease. Performing a combination of tests will likely help, although the magnitude of the improvement is minimal. These authors caution clinicians placing confidence in the physical examination tests for SLAP lesions rather we suggest that clinicians rely on diagnostic imaging to confirm this diagnosis.

Keywords: SLAP; diagnosis; physical examination; shoulder.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Dr. Bryant reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study; Dr. Johnson reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study; personal fees from Western University, grants from Canadian Institute for Health Research, outside the submitted work; Dr. LeBel reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study, outside the submitted work; Dr. Litchfield reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study; personal fees from Smith and Nephew, Wright Medical, Biometrics, Kalur Law Firm, Arthrosurface, outside the submitted work; Dr. Moro reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study; Dr. Somerville reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study; Dr. Willits reports grants from Internal Research Fund, London Health Sciences Center, during the conduct of the study; other from Smith and Nephew, outside the submitted work.

Figures

Fig. 1
Fig. 1
Thresholds in the diagnostic process.
See this image and copyright information in PMC

References

    1. Snyder S J, Karzel R P, Del Pizzo W, Ferkel R D, Friedman M J. SLAP lesions of the shoulder. Arthroscopy. 1990;6(04):274–279. - PubMed
    1. Maffet M W, Gartsman G M, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(01):93–98. - PubMed
    1. Powell S E, Nord K D, Ryu R KN. The diagnosis, classification, and treatment of SLAP lesions. Oper Tech Sports Med. 2004;12:99–110.
    1. Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20(03):231–236. - PubMed
    1. Kim S H, Ha K I, Ahn J H, Kim S H, Choi H J. Biceps load test II: a clinical test for SLAP lesions of the shoulder. Arthroscopy. 2001;17(02):160–164. - PubMed