Abstract:Background:Injuries to the posterior labrum are less common and more difficult to diagnose compared to anterior labral pathology. This may be in part due to difficulties in preoperative diagnosis. Posterior labral injuries cause abnormal loading of the rotator cuff with subsequent weakness. Examination using the O'Briens test tightens the posterior capsule and posteriorly translates the humeral head, stressing the labrum resulting in pain and weakness.Method:A retrospective study.Results:Of 74 patients diagnos… Show more
“… Fig. 2 Useful clinical tests for rugby players: a and b WPIT (Wrightington posterior instability test) [ 31 ]: inability to maintain the arm in flexion and adduction against resistance with the scapula corrected. c Modified dynamic labral shear test [ 20 ] for labral tears.…”
Section: Diagnosismentioning
confidence: 99%
“…2. Posterior instability (a) Wrightington posterior instability test (WPIT) [31] Posterior instability can be difficult to diagnose in large, muscular athletes. The usual posterior instability tests (Jerk and posterior apprehension tests) are only positive in patients with gross posterior instability.…”
Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete-specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures.Level of evidence V.
“… Fig. 2 Useful clinical tests for rugby players: a and b WPIT (Wrightington posterior instability test) [ 31 ]: inability to maintain the arm in flexion and adduction against resistance with the scapula corrected. c Modified dynamic labral shear test [ 20 ] for labral tears.…”
Section: Diagnosismentioning
confidence: 99%
“…2. Posterior instability (a) Wrightington posterior instability test (WPIT) [31] Posterior instability can be difficult to diagnose in large, muscular athletes. The usual posterior instability tests (Jerk and posterior apprehension tests) are only positive in patients with gross posterior instability.…”
Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete-specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures.Level of evidence V.
“…With the shoulder flexed, adducted, and internally rotated there is direct contact between the lesser tuberosity, subscapularis tendon, and superior labrum-biceps complex. 33 Furthermore, as the patient resists downward force, the humeral head can translate posterior and superior and place stress on 31 Also, with the elbow extended and the forearm pronated, the long head of the biceps is under tension; thus, the force can be applied directly to the superior labrum-biceps complex. 29 The crank test was the second most sensitive of this group and was included in the most sensitive combined test sequences.…”
Background: Superior labrum anterior to posterior (SLAP) lesions are targeted on physical examination using a variety of provocative maneuvers. Purpose/Hypothesis: The purpose was to conduct a systematic review on the performance of physical examination maneuvers in diagnosing SLAP lesions and to perform a meta-analysis comparing the sensitivity and specificity of these examinations both individually and in combination. The null hypothesis stated that there would be no significant difference in the sensitivity or specificity of the included physical examination tests, neither individually nor in combination. Study Design: Meta-analysis and systematic review; Level of evidence, 4. Methods: A systematic review was performed with the inclusion criteria of studies that reported either the sensitivities and specificities or the number of true-positive, true-negative, false-positive, or false-negative results for at least 1 maneuver for identifying SLAP lesions. A meta-analysis was performed to determine the sensitivity and specificity of individual maneuvers. Additional analysis determined the performance of these maneuvers when combined in series and parallel. In series, all must be present to be considered positive. In parallel, any single positive test forces the overall combination to be considered positive. Only tests that were included in ≥3 studies were considered in the meta-analysis and those included in ≥4 studies were considered in the combination analysis. Results: Overall, 862 studies were identified, 18 of which were included in the systematic review and meta-analysis. The physical examinations included were the O’Brien (n = 16), speed (n = 8), Yergason (n = 6), anterior slide (n = 8), crank (n = 7), Jobe (n = 5), dynamic labral shear (n = 3), Kim 2 (n = 3), and biceps groove tenderness tests (n = 3). All combinations of 2 to 5 maneuvers in both series and parallel were considered. The O’Brien and crank test combination was the most sensitive 2-test combination in both parallel and series. The Yergason and anterior slide test combination was the most specific 2-test combination in parallel and series. Conclusion: This systematic review and meta-analysis reports an updated meta-analysis considering the sensitivity and specificity of common physical examination maneuvers used in the diagnosis of SLAP lesions and considers these values for tests in both series and parallel combinations. The present analysis demonstrates improved specificities when tests are considered in series and improved sensitivities when considered in parallel combination.
“…In Neer’s test, reproduction of pain at the anterior edge of the acromion/lateral deltoid was considered as a positive response for impingement. In addition, an O’Brien test was performed to evaluate superior labrum anterior and posterior (SLAP) tear 11 , 12 and ER tests with the upper arm in a neutral position (ER test) and in an abduction position (abduction and ER [ABER] test; abduction to 90–100, extension to 10–15, and maximal ER) were also performed. 13 , 14 O’Brien test is considered as positive for a SLAP if pain felt “inside” the joint is felt to improve with the supination.…”
BackgroundAmong the various causes of shoulder pain, the glenoid labral tear is likely to be overlooked due to its ambiguous symptoms, especially if clinicians do not have a prior suspicion, making it difficult to diagnose, unlike adhesive capsulitis or a rotator cuff tear. Therefore, the aim of this study was to evaluate the clinical features of posterosuperior (PS) labral tear.MethodsOf the patients who visited the clinic, the medical records of patients with shoulder pain who underwent shoulder magnetic resonance imaging or ultrasound after intra-articular injection (arthrosonography) were investigated retrospectively. Based on these criteria, a total of 120 patients with adhesive capsulitis, rotator cuff problem, or PS labral tear were included for analysis in this study.ResultsIn the physical examination, all patients with a PS labral tear were positive on the O’Brien test (13/13, 100%) and the external rotation (ER) test with the upper arm in the abduction position (abduction and ER [ABER] test) (13/13, 100%), but they were negative on other tests, such as the Hawkins–Kennedy (1/13, 7.69%) and Neer (0/13, 0.00%) tests. Except one patient, all patients with a PS labral tear were negative on the ER test with the upper arm in the neutral position (ER test) (1/13, 7.69%). In the clinical history, all patients with a PS labral tear had a characteristic episode of shoulder pain occurring in the excessive ABER posture.ConclusionIn patients with characteristic physical findings (no definite loss of motion of the shoulder joint, negative in an ER test, but positive in an ABER test and O’Brien test), and with a clinical history of PS labral tear (a history of pain occurring with the excessive ABER posture), clinicians need to have a suspicion of PS labral tear and to identify the PS labral tear using MRI or arthrosonography
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