Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions

Swaringen, Jennifer C.; Mell, Amy G.; Langenderfer, Joseph E.; LaScalza, Suzanne; Hughes, R.; Kuhn, John E.

doi:10.1016/j.jse.2006.01.004

Cited by 9 publications

(9 citation statements)

References 30 publications

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“…Although SLAP lesion test assessment is prevalent in the literature, comparison between studies is difficult due to the lack of overlap of tests between similar studies. However, two studies support the findings of this study in that ACPU and Bicep II have both been reported to elicit large LHBB EMG amplitudes 1030 .…”

Section: Discussionsupporting

confidence: 88%

“…Clinically based evaluations of SLAP lesion tests account for the majority of studies to date; however, studies have also assessed test accuracy by attempting to validate the fundamental design behind various SLAP lesion tests 10, 15, 26, 30 . Provocative SLAP lesion tests, by definition, function to provoke labral symptoms (primarily pain) as a positive diagnostic sign, by reenacting one of two injury mechanisms.…”

Section: Introductionmentioning

confidence: 99%

“…The compressive load causes superior humeral head translation within the glenohumeral joint and can result in a collision between the humerus and labrum, potentially damaging the soft tissue of the labrum 1 . The ability of proposed SLAP lesion tests to reproduce the injury mechanisms that they were designed to replicate has been examined from several perspectives including anatomic 10, 15, 26 , kinematic 19 , and electromyographic 10, 30 methods and results illuminate the importance of design validation during the development of clinical testing procedures.…”

Section: Introductionmentioning

confidence: 99%

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Glenohumeral Muscle Activation During Provocative Tests Designed to Diagnose Superior Labrum Anterior-Posterior Lesions

et al. 2011

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Background Despite considerable medical advances, arthroscopy remains the only definitive means of Superior Labrum Anterior-Posterior (SLAP) lesion diagnosis. Natural shoulder anatomic variants limit the reliability of radiographic findings and clinical evaluations are not consistent. Accurate clinical diagnostic techniques would be advantageous due to the invasiveness, patient risk, and financial cost associated with arthroscopy. Purpose The purpose was to examine the behavior of the joint stabilizing muscles in provocative tests for SLAP lesions. Electromyography was used to characterize the muscle behavior, with particular interest in the long head biceps brachii (LHBB), as activation of the long head and subsequent tension in the biceps tendon should, based on related research, elicit labral symptoms in SLAP lesion patients. Study Design Controlled Laboratory Study Methods Volunteers (N=21) without a history of shoulder pathology were recruited. The tests analyzed were Active Compression, Speed's, Pronated Load, Biceps I, Biceps II, Resisted Supination External Rotation, and Yergason's. Tests were performed with a dynamometer to improve reproducibility. Muscle activity was recorded for the long and short heads of the biceps brachii, anterior deltoid, pectoralis major, latissimus dorsi, infraspinatus, and supraspinatus. Muscle behavior for each test was characterized by peak activation and proportion of muscle activity. Results Speed's, Active Compression Palm-Up, Bicep I and Bicep II, produced higher long head activations. Resisted Supination External Rotation, Bicep I, Bicep II, and Yergason's, produced a higher LHBB proportion. Conclusion Bicep I, and Bicep II elicited promising long head behavior (high activation and selectivity). Speed's and Active Compression Palm-Up elicited higher activation of the LHBB , and Resisted Supination and Yergason's elicited selective LHBB activity. These top performing tests utilize a unique range of test variables that may prove valuable for optimal SLAP test design and performance. Clinical Relevance This study examines several provocative tests that are frequently used in the clinical setting as a means of evaluating a potential SLAP lesion. [Review Only] What is known about the subject Detecting SLAP lesions in the clinical setting has been frequently examined in the relevant literature. In general, most studies report the accuracy of a SLAP lesion test after a group of patients with suspected SLAP lesions are diagnosed following arthroscopy, and very few of these studies have examined the biomechanical implications of these tests. [Review Only] What this study adds to existing knowledge To the best of the authors' knowledge this is the first study to examine these seven provocative test in parallel and in subjects with no history of shoulder pathology. Again, to the best of the authors' knowledge this study is also the first to examine both activation and selectivity of the long head of the biceps and six other joint stabilizing muscles. In this study...

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glenohumeral Muscle Activation During Provocative Tests Designed to Diagnose Superior Labrum Anterior-Posterior Lesions

et al. 2011

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“…The EMG activity levels of the biceps brachii long head for RSER testing in the current study are higher than those reported in the biceps load test using similar methods (Shanley et al, 2008), and also in comparison with other tests for SLAP lesions (Swaringen et al, 2006). The biceps load test for SLAP lesions resists elbow flexion from a similar position of shoulder abduction and elbow flexion (Kim et al, 2001a).…”

Section: Discussioncontrasting

confidence: 49%

“…The biceps load test recruited only minimal activity in biceps brachii long head (17.6% MVIC), probably because elbow flexion selectively recruits the brachialis muscle (Shanley et al, 2008). Although Swaringen et al (2006) did not evaluate the RSER test and the lack of clarity regarding the units reported in the article make comparison of data difficult, the comparison with the results of Shanley et al provides further evidence that resisted forearm supination is the key component in contributing to the moderately strong level of activity in biceps brachii long head during the RSER test.…”

Section: Discussionmentioning

confidence: 97%

The anatomical basis of the resisted supination external rotation test for superior labral anterior to posterior lesions

McCaughey¹,

Green²,

Taylor³

2009

Clinical Anatomy

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The majority of clinical tests used to diagnose superior labral anterior to posterior (SLAP) lesions of the shoulder have poor diagnostic accuracy, possibly related to a lack of anatomical validity for test procedures. The resisted supination external rotation (RSER) test is suggested to reproduce symptoms associated with a SLAP lesion by placing stress on the labrum through increasing tension in biceps brachii long head. The test requires supination of the forearm against resistance, while the shoulder is externally rotated passively. It was hypothesized that the RSER would increase activity in biceps brachii long head, thereby providing evidence of the anatomical validity of the test. Electromyography (EMG) was used to measure activity in biceps brachii long head and five other muscles potentially recruited during the RSER test in 12 healthy subjects. EMG amplitude was normalized against maximum voluntary isometric contraction for each muscle. Muscle activity values were averaged across five RSER trials and graded descriptively. Moderately strong activity was recorded in biceps brachii long head and supinator muscle throughout all phases of the RSER test. Brachialis was minimally active throughout the test. The results provide support for the anatomical basis of the RSER test, with the resisted forearm supination component of the test recruiting moderately strong levels of activity in biceps brachii long head throughout the test. Although the evidence of anatomical validity provides support for the RSER test as a clinical test for SLAP lesions of the shoulder, further tests of diagnostic accuracy are required.

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Disorders of the Long Head of the Biceps Tendon

Warth

Millett

2015

Physical Examination of the Shoulder

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Electromyographic analysis of physical examination tests for type II superior labrum anterior-posterior lesions

Cited by 9 publications

References 30 publications

Glenohumeral Muscle Activation During Provocative Tests Designed to Diagnose Superior Labrum Anterior-Posterior Lesions

Glenohumeral Muscle Activation During Provocative Tests Designed to Diagnose Superior Labrum Anterior-Posterior Lesions

The anatomical basis of the resisted supination external rotation test for superior labral anterior to posterior lesions

Disorders of the Long Head of the Biceps Tendon

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