The Evaluation of Various Physical Examinations for the Diagnosis of Type II Superior Labrum Anterior and Posterior Lesion

Abstract

Background

Many types of physical examinations have been used to diagnose superior labrum anterior and posterior lesions; no decisive clinical test is available for confirming the diagnosis.

Hypothesis

A selection from 10 well-established physical tests, alone or in combination, can be used to differentiate lesions with biceps anchor detachment from those with an intact biceps anchor with arthroscopic correlation.

Study Design

Case control study (diagnosis); Level of evidence, 3.

Methods

Among 297 patients who underwent shoulder arthroscopy between January 2004 and July 2005, 146 patients were enrolled in the study as a type II superior labrum anterior and posterior lesion group and an age-matched control group. Sensitivity, specificity, and predictive values of each test and all possible combinations of 2 and 3 tests were analyzed. The same procedures were repeated in patients younger than and older than 40 years.

Results

The sensitivities of the Whipple, O'Brien, apprehension, and compression-rotation tests and the specificities of the Yergason, biceps load II, and Kibler tests were relatively high. No single physical examination was found to be simultaneously highly sensitive and specific for the diagnosis of a type II superior labrum anterior and posterior lesion. When 2 of the 3 relatively sensitive tests (O'Brien, apprehension, or compression-rotation test) were combined with 1 of the 3 relatively specific tests (Speed, Yergason, or biceps load II test), sensitivity and specificity reached approximately 70% and 95%, respectively. Similar trends were noted in the younger and older patient groups and in the isolated type II superior labrum anterior and posterior lesion group.

Conclusion

The data suggest that some combinations of 2 relatively sensitive clinical tests and 1 relatively specific clinical test increase the diagnostic efficacy of superior labrum anterior and posterior lesions. Requiring 1 of the 3 chosen tests to be positive will result in a sensitivity of about 75%, whereas requiring all 3 to be positive will result in a specificity of about 90%.

Keywords

superior labrum anterior and posterior lesion (SLAP) lesion physical examination diagnostic value

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References

Andrews

Carson

Jr McLeod

. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13(5):337–341.

Bennett

. Specificity of the Speed's test: Arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. 1998;14(8):789–796.

Burkhart

Morgan

. The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637–640.

Guanche

Jones

. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19(5):517–523.

Holtby

Razmjou

Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: Comparison with arthroscopic findings. Arthroscopy. 2004;20(3):231–236.

Kibler

. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995;11(3):296–300.

Kim

Ahn

Choi

. Biceps load test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy. 2001;17(2):160–164.

Kim

Ahn

Kim

Choi

. Biceps load test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy. 2001;17(2):160–164.

Kim

Queale

Cosgarea

McFariand

. Clinical features of the different types of SLAP lesions: An analysis of one hundred and thirty-nine cases. Superior labrum anterior posterior. J Bone Joint Surg Am. 2003;85(1):66–71.

10.

Kvitne

Jobe

. The diagnosis and treatment of anterior instability in the throwing athlete. Clin Orthop Relat Res. 1993;291:107–123.

11.

McFarland

Kim

Savino

. Clinical assessment of three common tests for superior labral anterior-posterior lesions. Am J Sports Med. 2002;30(6):810–815.

12.

Nam

Snyder

. The diagnosis and treatment of superior labrum, anterior and posterior (SLAP) lesions. Am J Sports Med. 2003;31(5): 798–810.

13.

Neer

II . Anterior acromioplasty for the chronic impingement syndrome in the shoulder a preliminary report. J Bone Joint Surg Am. 1972;54(1):41–50.

14.

O'Brien

Pagnani

Fealy

McGlynn

Wilson

. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26(5):610–613.

15.

Parentis

Glousman

Mohr

Yocum

. An evaluation of the provocative tests for superior labral anterior posterior lesions. Am J Sports Med. 2006;34(2):265–268.

16.

Parentis

Mohr

ElAttrache

. Disorders of the superior labrum: Review and treatment guidelines. Clin Orthop Relat Res. 2002;400:77–87.

17.

Pfahler

Haraida

Schulz

. Age-related changes of the glenoid labrum in normal shoulders. J Shoulder Elbow Surg. 2003;12(1):40–52.

18.

Rowe

Zarins

Recurrent transient subluxation of the shoulder. J Bone Joint Surg Am. 1981;63(6):863–872.

19.

Savoie

III Field

Atchinson

Anterior superior instability with rotator cuff tearing: SLAC lesion. Orthop Clin North Am. 2001;32(3):457–461, ix.

20.

Snyder

Banas

Karzel

. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995;4(4):243–248.

21.

Snyder

Karzel

Del Pizzo

Ferkel

Friedman

. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–279.

22.

van Moppes

Veldkamp

Roorda

Role of shoulder ultrasonography in the evaluation of the painful shoulder. Eur J Radiol. 1995;19(2):142–146.

23.

Wilk

Reinold

Dugas

Arrigo

Moser

Andrews

. Current concepts in the recognition and treatment of superior labral (SLAP) lesions. J Orthop Sports Phys Ther. 2005;35(5):273–291.