Labral Instability Tests

SLAP Tests
1. O’Briens Active Compression Test: Distinguishes between superior labral and acromioclavicular abnormalities.  The patient flexes the affected arm to 90 degrees with the elbow in full extension.  The patient adducts the arm to 10-15 degrees medial to the sagittal plane of the body.  The arm is then internally rotated so the thumb is downward.  The examiner then applies a downward force to the arm.  A + test is pain with this and then reduced pain with the arm in the same position, but with the arm supinated.  Sensativity: 100%, Specificity: 99%, for labral pathology.

2. Anterior Slide Test: The patient is sitting or standing with their hands by their hips with thumbs facing posteriorly.  The examiner places a hand across the posterior aspect of the tested shoulder with the index finder extending over the anterior aspect of the acromion at the glenohumeral joint.  The examiners other hand is behind the tested arms elbow and a forward/slightly superiorly directed force is applied to the elbow/upper arm.  The patient is asked to push against this force.  A + test is pain in the anterior shoulder or pop/clicl in the same area. Sensativity: 78.4% and specificity: 91.5%  for SLAP lesion.

3. Crank Test: The patient is sitting with the arm elevated to 160 degrees in the scapular plane. The examinated applies a load in the axis of the humerus with one hand while the other applies humeral rotation.  A + test is pain during this test (usually with external rotation) with or without a click.  This test can also be performed supine, where the patient may be more relaxed.  Sensativity: 91% and Specificity: 93%.

Instability Tests:

1. Jobes Apprehension-Relocation Test: During the apprehension portion of the exam,the patient is supine with the arm abducted and externally rotated.  The examiner then pushes anteriorly on the posterior aspect of the humeral head and pain/apprehension is produced in patients with recurrent dislocations and patients with anterior subluxation will have pain but not apprehension.  The examiner then applies a posterior force on the humeral head for the relocation portion of the exam. Patients with primary impingement will have no change in symptoms but patients with secondary impingement patients will have pain relief.  The apprehension portion of the examination has a sensativity of 68% and specificity of 100%. The relocation portion of the examination has poor diagnostic value.

Tennent TD, Beach WR, Meyers JF.  Clinical Sports Medicine Update. A Review of the Special Tests Associated with Shoulder Examination: Part II: Laxity, Instability and Superior Labral Anterior and Posterior (SLAP) Lesions. Am J Sports Med. 2003:31;301-07.

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