SLAP Lesion Cluster 1 | Shoulder Assessment

According to a study done by Schlechter et al. (2009), a combination of the Active Compression Test and the Passive Distraction test yields a positive likelihood ratio of 7.0 for 2 positive tests and a negative likelihood ratio of 0.33 for two negative tests.
This test cluster therefore has moderate clinical value to confirm or rule out SLAP lesions.

Passive Compression Test

To perform this test, have your patient in supine-lying position at the edge of the table. Then elevate the affected arm to 150° in the coronal plane with the elbow in extension and the forearm in supination and the upper arm stabilized to prevent humeral rotation. Then gently pronate the forearm.

This test is considered positive if the pain is reported deep inside the glenohumeral joint either anteriorly or posteriorly.

It is postulated that this maneuver rotates the radial tuberosity, placing traction on the biceps, which in turn tensions the proximal head long head of the biceps anchor at the superior labrum, causing a “peel back” or “fishing mouthing” of the labrum.

Active Compression Test by O’Brien

To perform the test, ask your patient to flex his shoulders to 90°, bring the shoulders into 10 degrees of adduction and the first testing position is with your patient’s shoulders in complete internal rotation. Then ask your patient to resist downward pressure.

Subsequently, ask your patient to fully laterally rotate his shoulders and resist downward pressure again.

This test is positive for SLAP lesion if the pain that is provoked during the first testing position is lessened or disappears in the second testing position.

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

References

Schlechter, J. A., Summa, S., & Rubin, B. D. (2009). The passive distraction test: a new diagnostic aid for clinically significant superior labral pathology. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25(12), 1374-1379.