Medicine American Journal of Sports

Vol. 31, No. 2, 2003 Tests for Laxity, Instability, and SLAP Lesions 307
Biceps Load Test II
Kim et al. 8 described a second biceps load test in 2001 for
the assessment of SLAP lesions in shoulders without recurrent
dislocation. “The test is conducted with the patient
in the supine position. The examiner sits adjacent to
the patient on the same side as the shoulder and grasps
the patient’s wrist and elbow gently. The arm to be examined
is elevated to 120° and externally rotated to its maximal
point, with the elbow in the [sic] 90° flexion and the
forearm in the supinated position. The patient is asked to
flex the elbow while resisting the elbow flexion by the
examiner. The test is considered positive if the patient
complains of pain during the resisted elbow flexion and
also considered positive if the patient complains of more
pain from the resisted elbow flexion regardless of the
degree of pain before the elbow flexion maneuver. The test
is negative if pain is not elicited by the resisted elbow
flexion or if the preexisting pain during the elevation and
external rotation of the arm is unchanged or diminished
by the resisted elbow flexion.”
In the 2001 report, 127 shoulders were evaluated arthroscopically.
There were 38 positive tests. The sensitivity
was 90%, the specificity was 97%, the positive predictive
value was 92%, and the negative predictive value
was 96%.
DISCUSSION
A range of tests has recently been described for the SLAP
lesion. In contrast to the tests used to detect abnormalities
of the rotator cuff, described in Part I of these articles,
these tests use statistics to support their diagnostic power
and the original authors’ analyses all appear to produce
excellent sensitivity and specificity. Unfortunately, very
few of these new tests have undergone independent analysis
of their efficacy. Several of the tests are very similar
in appearance and there has been no anatomic study
performed to assess the effect of the tests on the biceps/
labral complex.
One observation, which may be reasonably made, is that
none of these tests is absolutely diagnostic for any one
pathologic entity. This implies that we should not rely
blindly on the clinical examination but use it as a part of
the diagnostic procedure, in conjunction with the history.
It must be remembered, as stated at the end of Part I,
that it is not appropriate for the clinician to use every test
on every patient. The purpose of this series of articles was
to provide the original descriptions of a number of tests
along with statistical analysis, if available, to allow clinicians
to decide which tests are worth using, how they
should be performed, and how to interpret the results.
REFERENCES
1. Faber KJ, Homa K, Hawkins RJ: Translation of the glenohumeral joint in
patients with anterior instability: Awake examination versus examination
with the patient under anesthesia. J Shoulder Elbow Surg 8: 320–323,
1999
2. Field LD, Savoie FH III: Arthroscopic suture repair of superior labral
detachment lesions of the shoulder. Am J Sports Med 21: 783–790, 1993
3. Gerber C, Ganz R: Clinical assessment of instability of the shoulder. With
special reference to anterior and posterior drawer tests. J Bone Joint Surg
66B: 551–556, 1984
4. Gross ML, Distefano MC: Anterior release test. A new test for occult
shoulder instability. Clin Orthop 339: 105–108, 1997
5. Jobe FW, Jobe CM: Painful athletic injuries of the shoulder. Clin Orthop
173: 117–124, 1989
6. Jobe FW, Kvitne RS: Shoulder pain in the overhand or throwing athlete.
The relationship of anterior instability and rotator cuff impingement. Orthop
Rev 18: 963–975, 1989
7. Kibler WB: Specificity and sensitivity of the anterior slide test in throwing
athletes with superior glenoid labral tears. Arthroscopy 11: 296–300, 1995
8. Kim SH, Ha KI, Ahn JH, et al: Biceps load test II: A clinical test for SLAP
lesions of the shoulder. Arthroscopy 17: 160–164, 2001
9. Kim SH, Ha KI, Han KY: Biceps load test: A clinical test for superior labrum
anterior and posterior lesions in shoulders with recurrent anterior dislocations.
Am J Sports Med 27: 300–303, 1999
10. Levy AS, Lintner S, Kenter K, et al: Intra- and interobserver reproducibility
of the shoulder laxity examination. Am J Sports Med 27: 460–463, 1999
11. Liu SH, Henry MH, Nuccion SL: A prospective evaluation of a new
physical examination in predicting glenoid labral tears. Am J Sports Med
24: 721–725, 1996
12. Mimori K, Muneta T, Nakagawa T, et al: A new pain provocation test for
superior labral tears of the shoulder. Am J Sports Med 27: 137–142, 1999
13. Neer CS II, Foster CR: Inferior capsular shift for involuntary inferior and
multidirectional instability of the shoulder. A preliminary report. J Bone
Joint Surg 62A: 897–908, 1980
14. O’Brien SJ, Pagnani MJ, Fealy S, et al: The active compression test: A
new and effective test for diagnosing labral tears and acromioclavicular
joint abnormality. Am J Sports Med 26: 610–613, 1998
15. Rowe CR, Zarins B: Recurrent transient subluxation of the shoulder.
J Bone Joint Surg 63A: 863–872, 1981
16. Silliman JF, Hawkins RJ: Classification and physical diagnosis of instability
of the shoulder. Clin Orthop 291: 7–19, 1993
17. Snyder SJ, Karzel RP, Del Pizzo W, et al: SLAP lesions of the shoulder.
Arthroscopy 6: 274–279, 1990
18. Speer KP, Hannafin JA, Altchek DW, et al: An evaluation of the shoulder
relocation test. Am J Sports Med 22: 177–183, 1994
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