Anterior Slide Test | SLAP Lesions | Shoulder Assessment

SLAP stands for a superior labral tear, anterior to posterior, and mainly occurs in the overhead throwing athlete. Isolated SLAP injuries are unusual and mostly occur together with other disorders, such as rotator cuff tears and instability. As we know that the labrum acts as a passive stabilizer to deepen the glenoid and prevent subluxation of the humeral head, mechanisms of injury are often related to traction, acute traumatic (often overhead-) events, the ‘peel-back’ mechanism, or heavy lifting.

A systematic review with meta-analyses from Symanski et al. (2017) suggests that for a diagnosis of SLAP tears, direct MR arthrography is the preferred method. In 2017, Somerville et al. assessed the diagnostic accuracy of physical examination tests to diagnose SLAP tears. Among others, the anterior slide test was included based on surgeon preference. The test yielded a sensitivity of 20% and specificity or 73.8% which translates to rather poor likelihood ratios and which is why the clinical value of this test to assess SLAP lesions is to be regarded as weak.

To conduct the test, the patient is either sitting or standing with their hands on their hips so that the thumbs point posteriorly. One hand is placed on top of the patient’s shoulder so that the last segment of the index finger extends over the anterior aspect of the acromion at the glenohumeral joint.
The other hand is placed behind the patient’s elbow and a forward and slightly upward-directed force will be applied to the arm. The patient is asked to resist said movement.

The test is considered positive if the patient has pain at the anterior aspect of the shoulder under the examiner’s hand and/or if a popping or clicking sensation is felt in the same area or if the patient’s familiar symptoms that occur during their overhead activities are reproduced.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other orthopedic tests to assess biceps pathology & SLAP lesions are:

• Active Compression Test of O’Brien
• Yergason’s Test
• Biceps Load I Test
• Biceps Load II Test
• 3-Pack Examination
• Crank Test
• Passive Distraction Test
• Labral Tension Test
• Upper Cut Test
• Supine Flexion Resistance Test
• Compression Rotation Test
• Dynamic Labral Shear Test
• Speeds Test
• Passive Compression Test
• Resisted Supine External Rotation Test

References

Somerville, L. E., Willits, K., Johnson, A. M., Litchfield, R., LeBel, M. E., Moro, J., & Bryant, D. (2017). Clinical assessment of physical examination maneuvers for superior labral anterior to posterior lesions. The Surgery Journal, 3(04), e154-e162.

Symanski, J. S., Subhas, N., Babb, J., Nicholson, J., & Gyftopoulos, S. (2017). Diagnosis of superior labrum anterior-to-posterior tears by using MR imaging and MR arthrography: a systematic review and meta-analysis. Radiology, 285(1), 101-113.