Resisted Supination External Rotation Test | Biceps Pathology Assessment | SLAP Lesion

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 2017, Somerville et al. assessed the diagnostic accuracy of physical examination tests to diagnose SLAP tears. Among others, the resisted supination external rotation test was included based on surgeon preference. The test yielded a sensitivity of 14,3% and specificity of 80,8% 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 in supine position with the scapula of the affected side close to the edge of the table. The examiner supports the arm at the elbow and hand and places the arm into 90 degrees of abduction with the elbow flexed to 65 to 70 degrees. The forearm is in neutral or slight pronation. Then the patient is asked to supinate the hand with maximal effort while the examiner maximally externally rotates the shoulder at which point the patient is asked to describe the symptoms.

The test is positive if the patient describes anterior or deep shoulder pain, clicking or catching in the shoulder, or reproduction of symptoms that occur during a throwing motion. Posterior pain, apprehension, or no pain during the test is not considered a positive result.

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
• Passive Compression Test
• Crank Test
• Compression Rotation Test
• Passive Distraction Test
• Dynamic Labral Shear Test
• Upper Cut Test
• Supine Flexion Resistance Test
• Anterior Slide Test
• Speeds Test
• Labral Tension Test
• 3-Pack-Examination

References

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.

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.