Labral Tension 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 suggests that for a diagnosis of SLAP tears, direct MR arthrography is the preferred method. In 2012, Cook et al. investigated the diagnostic accuracy of five orthopedic clinical tests for the diagnosis of SLAP lesions among which they included the labral tension test. In patients where an isolated SLAP lesion was the suspected scenario, the test yielded a sensitivity of 40% and specificity of 75% and thus lacking the capacity to independently rule in our rule out the condition. As most patients with SLAP lesions have other disorders as well the clinical value of this test remains weak.

To conduct the test the patient lies supine and the examiner places the patient’s arm in 12° of abduction and neutral forearm rotation. The shoulder is then taken to end-range external rotation. At end-range rotation, the examiner grasps the patient’s hand and asks him or her to supinate the forearm, against resistance, from the neutral position.

The test is considered positive if the patient has increased concordant pain with resisted supination.

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
• Compression Rotation Test
• Passive Distraction Test
• Dynamic Labral Shear Test
• Upper Cut Test
• Supine Flexion Resistance Test
• Anterior Slide Test
• Speeds Test
• Passive Compression Test
• Resisted Supine External Rotation Test

References

Cook, C., Beaty, S., Kissenberth, M. J., Siffri, P., Pill, S. G., & Hawkins, R. J. (2012). Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. Journal of shoulder and elbow surgery, 21(1), 13-22.

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.