TRIP

Physical examination tests are not valid for diagnosing SLAP tears: a review.

Clinical Journal of Sport Medicine, 2010

Comment on: OBJECTIVE: To critically evaluate the evidence for the use of physical examination procedures for diagnosing superior labrum anterior posterior (SLAP) lesions, by means of a systematic review.
DATA SOURCES: MEDLINE, EMBASE, and The Cochrane data bases were searched for studies published between January 1970 and June 2004, in 3 stages, using SLAP lesion; arthroscopy, shoulder joint and athletic injuries combined with testing and physical examination; and arthroscopy, shoulder joint and athletic injuries combined with sensitivity and specificity (total yield, 260 articles).
Studies were included if they focused on physical examination of SLAP lesions and presented original data on the accuracy of the test.
DATA EXTRACTION: Information on the number of participants, the study design, the physical test(s) evaluated, and the sensitivity, specificity, and positive and negative predictive value of the tests were extracted or calculated.
Study validity was evaluated (1-5 points: independent, blind comparison with a reference standard; inclusion of an appropriate spectrum of patients; all participants were assessed by the reference standard; replicable description of the test; and likelihood ratios presented or calculable).
MAIN RESULTS: The physical tests included from 1 to 6 of the anterior slide test, SLAPprehension test, biceps load tests, crank test, O'Brien test, active compression, compression rotation, Speed's test, Yergason's test, Jobe test, bicippital groove pain, and pain provocation.
The only study that passed all 5 methods criteria found that Speed's test and Yergason's test had sensitivity of 32% and 43%, and specificity of 79% and 75%, respectively; thus, the positive and negative likelihood ratios for Speed's test were 1.2727 and 0.9091 and for Yergason's test were 2.000 and 0.7272.
Whereas the test descriptions in the other reports were generally clear, only 7 of the other 14 studies passed 1 further methods criterion.
CONCLUSION: The accuracy of Speed's and Yergason's tests for diagnosing a SLAP lesion was poor in the only methodologically robust study reviewed.
The likelihood ratios for these tests could not rule in, or rule out, the presence of a SLAP lesion when compared with arthroscopic results.