Special physical examination tests for superior labrum anterior posterior shoulder tears are clinically limited and invalid: a diagnostic systematic review

The Snyder Classification of Superior Labrum Anterior and Posterior (SLAP) Lesions

“…Given the difficulties in reliably classifying SLAP lesions based on arthroscopic videos [8], it is not surprising that physical examination maneuvers [5,18] and MRI findings [21] are reported to be unreliable in correctly diagnosing SLAP lesions. In two systematic reviews of physical examination reliability and validity for diagnostic accuracy of SLAP tears [5,12], the methodologically robust studies determined that Speed's and Yergason's tests (among all maneuvers) showed sensitivity of 32% and 43% and specificity of 79% and 75%, respectively [5,12].…”

“…In two systematic reviews of physical examination reliability and validity for diagnostic accuracy of SLAP tears [5,12], the methodologically robust studies determined that Speed's and Yergason's tests (among all maneuvers) showed sensitivity of 32% and 43% and specificity of 79% and 75%, respectively [5,12]. The confidence interval for likelihood ratios all included 1.0, indicating that Speed's and Yergason's tests could not rule in or rule out a SLAP lesion in comparison to arthroscopy [12].…”

SLAP Lesions Part III: Return to Play After SLAP Repair

“…Patients who are ultimately diagnosed with arthroscopically proven SLAP lesions typically present with pain during overhead activities and mechanical symptoms of catching, locking, popping, or grinding [ 3 , 13 , 14 ]. Calvert et al published a systematic review concluding that the current literature as of 2008 lacks the validity necessary to be useful and suggested that no good physical examination tests exist for effectively diagnosing a SLAP lesion [ 15 ]. Burkhart et al reported that the Speed test and Active Compression Test (O'Brien's test) were found to be highly specifi c for anterior Type II SLAP lesions, whereas the modifi ed Jobe relocation test was highly specifi c for posterior SLAP lesions [ 16 ].…”

Physical Examination of the Shoulder

“…38 Description of these 45 and several studies question the methodology of many superior labral anterior posterior examination reports. 46,47 Despite the multitude of tests described to assess for superior labral pathology, diagnosis based on physical examination continues to be a challenge. We recommend using several physical examination maneuvers followed by advanced imaging if the suspicion of a superior labral lesion is high.…”