Original Articles
Clinical testing for tears of the glenoid labrum?

https://doi.org/10.1053/jars.2003.50104Get rights and content

Abstract

Purpose: With the increasing use of shoulder arthroscopy, diagnosis of glenoid labral lesions has become increasingly common. However, a physical examination maneuver that would allow a definitive clinical diagnosis of a glenoid labral tear, and more specifically a SLAP lesion, has been elusive. This study correlated the results of commonly used examination maneuvers with findings at shoulder arthroscopy. The working hypothesis was that 7 commonly used clinical tests, alone or in logical combinations, would provide diagnoses with reliability greater than the accepted standards for magnetic resonance imaging arthrography; i.e., greater than 95% sensitivity and specificity. Type of Study: Consecutive sample, sensitivity-specificity study. Methods: Sixty shoulders undergoing arthroscopy for a variety of pathologies were examined before surgery. All subjects submitted to the Speed test, an anterior apprehension maneuver, Yergason test, O'Brien test, Jobe relocation test, the crank test, and a test for tenderness of the bicipital groove. The examination results were compared with surgical findings and analyzed for sensitivity and specificity in the diagnosis of SLAP lesions and other glenoid labral tears. Results: The results of the O'Brien test (63% sensitive, 73% specific) and Jobe relocation test (44% sensitive, 87% specific) were statistically correlated with presence of a tear in the labrum and the apprehension test approached statistical significance. Performing all 3 tests and accepting a positive result for any of them increased the statistical value, although the sensitivity and specificity were still disappointingly low (72% and 73%, respectively). The other 4 tests were not found to be useful for labral tears, and none of the tests or combinations were statistically valid for specific detection of a SLAP lesion. Conclusions: Clinical testing is useful in strengthening a diagnosis of a glenoid labral lesion, but the sensitivity and specificity are relatively low. Thus a decision to proceed with surgery should not be based on clinical examination alone.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 5 (May-June), 2003: pp 517'523

Section snippets

Methods

A prospective diagnostic protocol was applied to 61 consecutive patients (62 shoulders) undergoing arthroscopy of the shoulder for a variety of activity-related complaints (Table 1).

. Preoperative Diagnoses in a Series of 60 Shoulders

Preoperative Primary DiagnosisNo. of Shoulders
SLAP lesion15
Labral tear4
Acromioclavicular DJD20
Subacromial impingement21

Abbreviation: DJD, degenerative joint disease.

Patients were included in the study only if this was their first surgery on the involved shoulder, if

Results

There were 48 men and 11 women in the study, with an average age of 38 years (range, 15 to 76 years). All but 1 patient could relate their shoulder pain to overuse or injury and all had failed conservative management for their respective problems. There were various mechanisms of the original injury, including overuse in 33 shoulders, dislocation in 17, trauma without dislocation in 6, traction injuries with an eccentric load on the involved upper extremity in 3, and an uncertain mechanism in 1

Discussion

Diagnosis of labral lesions before surgery, with or without MRI, is important for 3 reasons: First, specific patient consent is necessary for the operative repair of a labral lesion. That is, the surgeon cannot repair a labral lesion based on consent for a simple arthroscopic debridement or acromioplasty because the postoperative regime and the associated limitations are significantly different. Second, the availability of specialized equipment for arthroscopic repair of a torn labrum may be an

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Address correspondence and reprint requests to Carlos A. Guanche, M.D., The Orthopaedic Center, Suite 100, 7905 Golden Triangle Dr, Eden Prairie, MN 55344, U.S.A. E-mail: [email protected]

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