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 Biceps Load 1 test was included based on surgeon preference. The test yielded a sensitivity of 11,9% and specificity or 87,5% 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 lies in supine position. The examiner sits at a right angle to at the height of the shoulder to be assessed. The examiner gently grasps the patient’s wrist and elbow and abducts the arm to 90 degrees with the forearm supinated and the elbow flexed to 90 degrees. The patient is instructed to relax as much as possible and the examiner first performs a shoulder apprehension test.
When the patient becomes apprehensive to further external rotation of the shoulder, the external rotation is stopped. The patient is then asked to flex the elbow against the examiner’s resistance. Make sure to not change the degree of abduction and external rotation.
Ask the patient if this maneuver changed has changed the apprehension at all. The test is repeated and the patient is instructed not to pull the whole upper extremity but to just bend the elbow against resistance.
The test is positive if the apprehension doesn’t change or if the shoulder becomes more painful.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
Other orthopedic tests to assess biceps pathology & SLAP lesions are:
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