An Evaluation of the Provocative Tests for Superior Labral Anterior Posterior Lesions

Parentis, Michael A.; Glousman, Ronald E.; Mohr, Karen; Yocum, Lewis A.

doi:10.1177/0363546505279911

Cited by 89 publications

(69 citation statements)

References 26 publications

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“…The researchers could have blinded the surgeons to the findings of the clinical testing, which would have improved the paper's overall quality, but in the population investigated it appears an accurate test. However, findings from other authors 12,31,35,36,41,47 investigating the same test (TABLE 6), including higher quality papers, did not confirm this accuracy.…”

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confidence: 79%

“…The active compression test 39 was investigated by 8 other authors 12,24,30,[34][35][36]41,47 other than O'Brien et al, 39 with none reporting values similar to those reported in the original paper.…”

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confidence: 96%

“…Therefore, positive responses found with testing cannot be accurately attributed to the SLAP lesions themselves. These concurrent pathologies included bursitis, 2 12,14,21,24,35,41 A number of the authors whose reports were reviewed in this paper provided clear explanations for the anatomical basis of the test under investigation. 2,14,20,21,31,[34][35][36]39 Although this was not considered under the QUADAS scoring, such provision strengthens the quality of the paper and test itself.…”

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confidence: 97%

“…These subtypes make sense clinically but make an analysis of the data more difficult. Parentis et al 41 only investigated type I or II lesions, not considering types III or IV. Some authors considered type I lesions as a normal variant and subsequently excluded them as a positive surgical finding.…”

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confidence: 99%

“…A change of arm position from full internal to full external shoulder rotation for the second component of the test, as would appear to be the intent described in the text, will alter the stress on a number of different structures, in particular, the subacromial and subcoracoid structures, not simply the superior labrum and biceps anchor. Thus a difference in response in the 2 41 while others considered the perception of a click positive. 27 Therefore, these variations and inconsistencies reduce the validity of a test and may help explain the lack of agreement between the reported accuracy of the tests.…”

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confidence: 99%

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Diagnostic Accuracy of Clinical Tests for Superior Labral Anterior Posterior Lesions: A Systematic Review

Dessaur

Magarey²

2008

J Orthop Sports Phys Ther

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As surgical procedures have advanced, so has our ability to diagnose and treat such injuries, as we have become more aware of the labral structure and the nature of SLAP injuries. The superior labrum has been found to have a loose attachment to T he surgical management of superior labral anterior posterior (SLAP) lesions of the shoulder has advanced in recent years, as arthroscopic techniques have led to a better understanding of labral anatomy and pathomechanics. With the complicated injuries that may occur at this site, greater emphasis is placed on accurate diagnosis and treatment to return patients to full function.STUDY DESIGN: Systematic literature review. OBJECTIVES:To conduct a systematic review of case series and clinical trials that investigate the diagnostic accuracy of clinical tests for superior labral anterior posterior (SLAP) lesions. BACKGROUND: Primary contact practitionersare often presented with shoulder problems and use a battery of clinical tests to reach a diagnosis. Early detection of SLAP pathology may lead to more optimal interventions and better outcomes for patients. METHODS AND MEASURES:The OVID search interface was utilized with MEDLINE, AHMED, CI-NAHL, and SPORTDiscus databases searched from 1996 to 2006. Studies were retrieved that included patients with shoulder pain who underwent at least 1 clinical shoulder test for SLAP lesions. For an article to be included in this review, the results of the clinical tests needed to be compared with findings on arthroscopy. Quality of the manuscripts included in this review were rated using the QUA-DAS appraisal tool, so comparisons could be made across studies. RESULTS:Seventeen published manuscripts fit the inclusion/exclusion criteria and were used for this review. Eight studies were found to be of high quality. Within these 8 studies, 1 group of authors reported high diagnostic accuracy values for the crank test: sensitivity, 91% (95% confidence interval [CI], 76%-97%); specificity, 93% (95% CI, 79%-98%); positive likelihood ratio, 13.6 (95% CI, 3.6-52.1); and negative likelihood ratio, 0.1 (95% CI, 0.0-0.3). One study on the resisted supination external rotation test also scored high on the QUADAS and reported diagnostic accuracy values of 83% (95% CI, 66-92), 82% (95% CI, 52-95), 4.6 (95% CI, 1.3-16.1), and 0.20 (95% CI, 0.1-0.5), respectively. Of significance is the fact that the majority of papers reporting highly accurate clinical diagnostic tests were of low quality, with the results not supported by other authors.CONCLUSION: It appears that no single test is sensitive or specific enough to determine the presence of a SLAP lesion accurately. Further research is required to determine whether subgrouping of patients by mechanism of injury or the type of SLAP lesion may improve diagnostic accuracy. Determining the diagnostic accuracy of a combination of 2 or more tests is also needed. Ther 2008;38(6):341-352. doi:10.2519/jospt.2008 The vascularity of the labrum is less in the superior and anterosuperior regions compared to the inferior...

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confidence: 79%