Testing for SLAP Lesions of the ShoulderThrowing athletes are at risk for a superior labrum anterior and posterior (SLAP) lesion. This is a tear of the labrum, the rim of cartilage around the shoulder socket. It is classified into four groups or categories depending on severity and associated soft tissue injury.
The most common SLAP injury is type II. This refers to a tear near the site where the biceps muscle inserts into the bone. Surgery to repair the damage is often needed. Making the diagnosis can be a challenge. Imaging studies such as magnetic resonance arthrography (MRA) are expensive. And an MRA isn't always able to distinguish a SLAP tear from other problems. Arthroscopic exam gives a clear diagnosis but it is an invasive procedure.
There are many physical tests that can be applied by an examiner. In this study, 10 of those tests are evaluated alone and in combination with one another. The tests included Speed's test, Yergason's, anterior apprehension, relocation, compression-rotation, O'Brien, Kibler, biceps load II, Whipple test, and biceps groove tenderness. The hope was to find a single test or a group of tests that could reliably identify a type II SLAP lesion.
The authors described each of the tests. Each patient had a shoulder injury and had an arthroscopic exam to identify the problem. Two groups of patients were compared. The first group had isoated type II SLAP lesions or type II SLAP lesions along with some other injury. A second (control) group had a shoulder problem but did not have a SLAP lesion and the biceps tendon was not damaged.
Everyone in both groups was tested the day before arthroscopic surgery was done to repair the injury or injuries. All 10 tests were performed on each patient. The results were compared and analyzed for sensitivity (how well a test correctly identifies a condition), specificity (measure of the test's effectiveness), and predictive values. Combinations of two and three tests were also analyzed for the same values.
The diagnostic accuracy of each test was reviewed for two different age groups (40 years old and younger, older than 40). Some of the tests were more accurate with younger patients. But there wasn't one individual test that could diagnose a type II SLAP lesion. In other words, it wasn't possible with any of these clinical tests to tell when the biceps anchor was detached. Results of combining tests weren't any different between the two age groups.
The authors concluded that clinical tests are helpful but arthroscopic exam is needed to confirm a type II SLAP lesion. When choosing from among the 10 tests, two tests should be selected from the O'Brien, anterior apprehension, and compression-rotation tests. One test should be done from the Speed, Yergason,and biceps load II tests.
Only one test from the first group of three must be positive to be sensitive enough to suggest a type II SLAP lesion. If all three are positive, then the specificity increases. Using this method helps the examiner save time. Instead of performing all 10 tests, only three are really needed for good results.
Joo Han Oh, MD, et al. The Evaluation of Various Physical Examinations for the Diagnosis of Type ii Superior Labrum Anterior and Posterior Lesion. In The American Journal of Sports Medicine. February 2008. Vol. 36. No.2. Pp. 353-359.
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