SLAP Lesion Cluster 2 | Shoulder Assessment

Long head of the biceps pathology is an increasingly recognized generator of shoulder pain and functional impairment in symptomatic patients. Physicians are faced with diagnostic challenges owing to nonspecific clinical presentations and a lack of direction based on physical examination findings. For this reason,Rosas et al. (2017)  conducted a literature review and have come up with a test cluster. They found that the uppercut test combined with tenderness to palpation of the long head of the biceps had the highest accuracy to diagnose pathology of the proximal biceps with a sensitivity of 88.3% and a specificity of 93.3%. Although accuracy seems to be high, this combination has not been confirmed by other studies or reviews yet, which is why we give it a moderate clinical value in practice.

Uppercut Test

To perform the test, your patient’s shoulder is in neutral position and he is asked to flex his elbow to 90 degrees, fully supinate the forearm and make a fist. The examiner covers the patient’s wrist with his contralateral hand and asks the patient to rapidly bring their hand up and across the body towards the chin, like in an uppercut punch in boxing, while the examiner gives resistance.
This test is positive in case of pain or a painful pop over the anterior shoulder.

Long Head of the Biceps Palpation

Afterward, palpate the extra-articular long biceps tendon in the bicipital groove with the patient’s arm in neutral. You can find the bicipital groove if you first palpate for the coracoid process. Then move about 1-2 centimeters lateral to land in the bicipital groove. You can confirm that your palpation is on the correct spot if you manually internally and externally rotate your patient’s shoulder. You should then feel the biceps tendon moving under your fingers. Be aware that this will be more difficult in patients with a well-developed anterior deltoid muscle which is overlaying the biceps tendon. This test is scored positive if the patient reports tenderness upon palpation.

The test cluster is considered positive if both tests score positive and it is considered negative if both items score negatively. In case one is positive and the other is negative, the test outcome is not really informative as individually both tests have a rather weak diagnostic accuracy:

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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

• Yergason’s Test
• Biceps Load I Test
• Biceps Load II Test
• 3-Pack Examination
• Crank Test
• Compression Rotation 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
• Labral Tension Test
• SLAP Lesion Cluster 1

References

Rosas, S., Krill, M. K., Amoo-Achampong, K., Kwon, K., Nwachukwu, B. U., & McCormick, F. (2017). A practical, evidence-based, comprehensive (PEC) physical examination for diagnosing pathology of the long head of the biceps. Journal of shoulder and elbow surgery, 26(8), 1484-1492.