Two New Clinical Examination Tests to Detect a Superior Labral Tear / SLAP Tear

It seems like once or twice a year I read an article about a new test to detect superior labral injuries of the shoulder, or SLAP labral tears.  Seems like the “best” test has been published many times!  With so many tests out there to detect SLAP tears, how do you choose which to perform on your patients?  Certainly you can’t perform them all?  Or should you?!?  I am working on a series of posts that discuss SLAP tears in detail, including classification, injury mechanisms, examination, and of course rehabilitation.

Do you know what it means when you have several examination techniques to determine the same pathology?

That is right, you guessed it, they all stink!  That is actually not true but wanted to state my case well.  Although there is no “gold standard” special test to detect SLAP tears, like the Lachman is for ACL injuries, there are some very useful tests if you know how to best use them.  The difficulty with SLAP test is that different tests are best used for different types of SLAPs or different mechanisms for SLAP injuries.  I will explain more in an upcoming post later this week.

Well, I am here to introduce to you two more tests to add to your bag of tricks!  I wanted to kick off the SLAP series with a new video that I have on YouTube that demonstrates these two tests.  These were actually published in a paper I wrote in JOSPT a few years ago, but I have modified them a little and wanted to share.  These two tests are both excellent at detecting peel-back SLAP lesions, specifically in overhead throwing athletes, but are useful for any population.  I share these two tests because I know that there is a lot of confusion regarding the “best” test.  These may not be them, but in my hands, both have been extremely helpful and, more importantly, accurate.

Pronated Load

The first test is the “Pronated Load Test,” it is performed in the supine position with the shoulder abducted to 90° and externally rotated.  However, the forearm is in a fully pronated position to increase tension on the biceps and subsequently the labral attachment.  When maximal external rotation is achieved, the patient is instructed to perform a resisted isometric contraction of the biceps to simulate the peel-back mechanism.  This test combines the active bicipital contraction of the biceps load test with the passive external rotation in the pronated position, which elongates the biceps.  A positive test is indicated by discomfort within the shoulder.

Resisted Supination External Rotation Test

The second new test was recently described by Myers in AJSM, called the “Resisted Supination External Rotation Test.”  Dr. Myers was a fellow at ASMI and a good friend of mine, he really wanted to call this the SUPER test (for SUPination ER) but I was one of many that advised him against this for obvious reasons!  During this test, the patient is positioned in 90° of shoulder abduction, and 65-70° of elbow flexion and the forearm in neutral position.  The examiner resists against a maximal supination effort while passively externally rotating the shoulder.  Myers noted that this test simulates the peel-back mechanism of SLAP injuries by placing maximal tension on the long head of the biceps by supinating.  Myers’ study of 40 patients revealed that this test had better sensitivity (82.8%), specificity (81.8%), positive predictive value (PPV) (92.3%), negative predictive value (NPV) (64.3%), and diagnostic accuracy  (82.5%) compared to the crank test and extremely popular O’Brien’s or active compression test.  A positive test is indicated by discomfort within the shoulder.

Have you tried these tests before?  Where they as accurate for you as they were for me?  These videos are taken from my Clinical Examination of the Shoulder DVD with Kevin Wilk.