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Abstract

Background

The reported accuracy of clinical tests for superior labral anterior posterior lesions is extremely variable. Pooling results from multiple studies of higher quality is necessary to establish the best clinical tests to use.

Hypothesis

Certain clinical tests are superior to others for diagnosing the presence or absence of a superior labral anterior posterior lesion.

Study Design

Meta-analysis.

Methods

A literature search of MEDLINE (1966–2007), CINAHL (1982–2007), and BIOSIS (1995–2007) was performed for (labrum OR labral OR SLAP OR Bankart) AND (shoulder OR shoulder joint OR glenoid) AND (specificity OR sensitivity AND specificity). Identified articles were reviewed for inclusion criteria. Sensitivity and specificity values were recorded from each study and used for meta-analysis.

Results

Six of 198 identified studies satisfied the eligibility criteria. Active compression, anterior slide, crank, and Speed tests were analyzed using receiver operating characteristic curves. The accuracy of the anterior slide test was significantly inferior to that of the active compression, crank, and Speed tests. There was no significant difference in test accuracy found among active compression, crank, and Speed tests. Between studies, methodological scores did not significantly affect sensitivity and specificity values.

Conclusion

The anterior slide test is a poor test for detecting the presence of a labral lesion in the shoulder. Active compression, crank, and Speed tests are more optimal choices. Clinicians should choose the active compression test first, crank second, and Speed test third when a labral lesion is suspected.

Keywords

physical examination sensitivity specificity superior labral anterior posterior (SLAP) lesions

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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.

Berg

Ciullo

. A clinical test for superior glenoid labral or “SLAP” lesions. Clin J Sport Med 1998;8(2):121–123.

BIOSIS [database online]. Philadelphia, Pa: Thomson Reuters; 2008.

Carreira

Mazzocca

Oryhon

Brown

Hayden

Romeo

. A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up. Am J Sports Med 2006;34(5):771–777.

CINAHL [database online]. Ipswich,Mass: EBSCO Publishing; 2008.

Cochrane Methods Group on Systematic Review of Screening and Diagnostic Tests. Recommended methods. Available at: som.flinders.edu.au/fusa/cochrane/ . Retrieved June 1996.

de Graaf

Prak

Bierma-Zeinstra

Thomas

Peul

Koes

. Diagnosis of lumbar spinal stenosis: a systematic review of the accuracy of diagnostic tests. Spine 2006;31(10):1168–1176.

Dinnes

Loveman

McIntyre

Waugh

. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess (Winchester, England) 2003;7(29):iii 1–166.

Gillan

Gilbert

Andrew

. Influence of imaging on clinical decision making in the treatment of lower back pain. Radiology 2001;220(2):393–399.

10.

Green

Taylor

Mirkovic

Perrott

. An evaluation of the anatomic basis of the O’Brien active compression test for superior labral anterior and posterior (SLAP) lesions. J Shoulder Elbow Surg 2008;17(1):165–171.

11.

Guanche

Jones

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

12.

Holleman

Jr Simel

. Does the clinical examination predict airflow limitation?. JAMA 1995;273(4):313–319.

13.

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.

14.

Irwig

Macaskill

Glasziou

Fahey

. Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol 1995;48(1):119–130 discussion 131–132

15.

Jones

Galluch

. Clinical assessment of superior glenoid labral lesions: a systematic review. Clin Orthop Relat Res 2007;455:45–51.

16.

Kim

Ahn

Kim

Choi

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

17.

Kim

Han

. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. Am J Sports Med 1999;27(3):300–303.

18.

Kim

Choi

. Results of arthroscopic treatment of superior labral lesions. J Bone Joint Surg Am 2002;84(6):981–985.

19.

Kim

Park

Jeong

Shin

. The Kim test: a novel test for posteroinferior labral lesion of the shoulder. A comparison to the jerk test. Am J Sports Med 2005;33(8):1188–1192.

20.

Kim

Choy

Joo

Chung

. The passive compression test: a new clinical test for superior labral tears of the shoulder. Am J Sports Med 2007;35(9):1489–1494.

21.

Kirkley

Litchfield

Thain

Spouge

. Agreement between magnetic resonance imaging and arthroscopic evaluation of the shoulder joint in primary anterior dislocation of the shoulder. Clin J Sport Med 2003;13(3):148–151.

22.

Liu

Henry

Nuccion

Shapiro

Dorey

. Diagnosis of glenoid labral tears: a comparison between magnetic resonance imaging and clinical examinations. Am J Sports Med 1996;24(2):149–154.

23.

Liu

Henry

Nuccion

. A prospective evaluation of a new physical examination in predicting glenoid labral tears. Am J Sports Med 1996;24(6):721–725.

24.

Magee

. Orthopedic Physical Assessment. 4th ed. Philadelphia, Pa: WB Saunders; 2002.

25.

Magee

Williams

Mani

. Shoulder MR arthrography: which patient group benefits most?. AJR Am J Roentgenol 2004;183(4):969–974.

26.

Magee

Williams

. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. AJR Am J Roentgenol 2006;187(6):1448–1452.

27.

McFarland

Kim

Savino

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

28.

MEDLINE [database online]. Baltimore, Md: Community of Science; 2008.

29.

Mimori

Muneta

Nakagawa

Shinomiya

. A new pain provocation test for superior labral tears of the shoulder. Am J Sports Med 1999;27(2):137–142.

30.

Mirkovic

Green

Taylor

Perrott

. Accuracy of clinical tests to diagnose superior labral anterior and posterior (SLAP) lesions. Phys Ther Rev 2005;10(1):5–14.

31.

Myers

Zemanovic

Andrews

. The resisted supination external rotation test: a new test for the diagnosis of superior labral anterior posterior lesions. Am J Sports Med 2005;33(9):1315–1320.

32.

Nakagawa

Yoneda

Hayashida

Obata

Fukushima

Miyazaki

. Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder. Arthroscopy 2005;21(11):1290–1295.

33.

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.

34.

Schweitzer

Spettell

. Internal derangements of the shoulder: decision tree and cost-effectiveness analysis of conventional arthrography, conventional MRI, and MR arthrography. Skeletal Radiol 1999;28(12):670–678.

35.

Pandya

Colton

Webner

Sennett

Huffman

. Physical examination and magnetic resonance imaging in the diagnosis of superior labrum anterior-posterior lesions of the shoulder: a sensitivity analysis. Arthroscopy 2008;24(3):311–317.

36.

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.

37.

Paxinos

Walton

Rutten

Muller

Murrell

. Arthroscopic stabilization of superior labral (SLAP) tears with biodegradable tack: outcomes to 2 years. Arthroscopy 2006;22(6):627–634.

38.

Reitsma

Glas

Rutjes

Scholten

Bossuyt

Zwinderman

. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 2005;58(10):982–990.

39.

Rutjes

Reitsma

Di Nisio

Smidt

van Rijn

Bossuyt

. Evidence of bias and variation in diagnostic accuracy studies. CMAJ 2006;174(4):469–476.

40.

Sackett

Straus

Richardson

Rosenberg

Haynes

. Evidence-Based Medicine. Philadelphia, Pa: Churchill Livingstone; 2000.

41.

Sasaki

Saito

Yodono

. Labral-ligamentous complex of the shoulder: evaluation with double oblique axial MR arthrography. Acta Radiol 2003;44(4):435–439.

42.

Scholten

Deville

Opstelten

Bijl

van der Plas

Bouter

. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. J Fam Pract 2001;50(11):938–944.

43.

Scholten

Opstelten

van der Plas

Bijl

Deville

Bouter

. Accuracy of physical diagnostic tests for assessing ruptures of the anterior cruciate ligament: a meta-analysis. J Fam Pract 2003;52(9):689–694.

44.

Sehgal

Shah

McKenzie-Brown

Everett

. Diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: a systematic review of evidence. Pain Physician 2005;8(2):211–224.

45.

Shah

Everett

McKenzie-Brown

Sehgal

. Discography as a diagnostic test for spinal pain: a systematic and narrative review. Pain Physician 2005;8(2):187–209.

46.

Speed

. Shoulder pain. Clin Evid 2005;14:1543–1560.

47.

Stetson

Templin

. The crank test, the O’Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. Am J Sports Med 2002;30(6):806–809.

48.

Waldt

Burkart

Lange

Imhoff

Rummeny

Woertler

. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. AJR Am J Roentgenol 2004;182(5):1271–1278.

49.

Westwood

Whiting

Kleijnen

. How does study quality affect the results of a diagnostic meta-analysis?. BMC Med Res Methodol 2005;5(1):20.

50.

Whiting

Rutjes

Reitsma

Glas

Bossuyt

Kleijnen

. Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Int Med 2004;140(3):189–202.

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A Meta-analysis Examining Clinical Test Utility for Assessing Superior Labral Anterior Posterior Lesions

Abstract

Background

Hypothesis

Study Design

Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material