Biceps load test II: A clinical test for SLAP lesions of the shoulder

doi:10.1053/jars.2001.20665

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 17, Issue 2, February 2001, Pages 160-164

https://doi.org/10.1053/jars.2001.20665 Get rights and content

Abstract

Purpose: The purpose of this report is to describe the biceps load test II for evaluating the superior labral anterior and posterior (SLAP) lesions. Type of Study: This is a double-blind study in consecutive data, which includes diagnostic accuracy of a test using sensitivity, specificity, and interexaminer reliability. Methods: In the supine position, the arm is elevated to 120° and externally rotated to its maximal point, with the elbow in the 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. The test is negative if pain is not elicited or if the pre-existing pain during the elevation and external rotation of the arm is unchanged or diminished by the resisted elbow flexion. A prospective study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test II. Two independent examiners were assigned to perform the new diagnostic test. The results of the tests were confirmed during the arthroscopic examination. Results: A positive test result in 38 subjects correlated with a SLAP lesion in 35 patients and an intact biceps-superior labrum in 3 patients. A negative test result in 89 patients correlated with an intact superior labrum complex in 85 patients, whereas 4 patients with a negative test result had a type II SLAP lesion. The biceps load test II had a sensitivity of 89.7%, a specificity of 96.9%, a positive-predictive value of 92.1%, a negative-predictive value of 95.5%, and a kappa coefficient of 0.815. The abduction and external rotation of the shoulder during the test changes the relative direction of the biceps fiber in a position of oblique angle to the posterosuperior labrum. The resisted contraction of the biceps increases the pain generated on the superior labrum that is already peeled off the glenoid margin in the abducted and externally rotated position. Conclusions: The biceps load test II is an effective diagnostic test for SLAP lesions.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 2 (February), 2001: pp 160–164

Section snippets

Methods

A prospective study was performed in 127 patients to evaluate the diagnostic accuracy for the biceps load test II. Of the 127 patients, 89 were men and 38 women, with the average age being 30.6 years (range, 15 to 52 years). Ninety-one patients (71.7%) had a dominant shoulder involved and 36 (28.3%) were involved in athletic activities such as baseball, tennis, basketball, soccer, volleyball, and swimming. The patients were experiencing shoulder pain and underwent arthroscopic examination

Results

Of the 127 shoulders, the biceps load test II was positive in 38 and negative in 89. The arthroscopic examination revealed type II SLAP lesions in 39 shoulders. Of the 38 shoulders with a positive test result, 35 had a type II SLAP lesion while the other 3 had an intact superior labrum. Of the 89 shoulders with a negative test result, 4 had type II SLAP lesions, whereas the other 85 shoulders had other abnormalities such as subacromial impingement or a rotator cuff tear. The accuracy of the

Discussion

The biceps–superior labral complex is recognized as a central part of the shoulder mechanism.4, 9, 11, 13 Because this complex has an important role in the stabilizing function of the glenohumeral joint, proper diagnosis of the lesion is considered critical for appropriate treatment. However, an accurate clinical diagnosis of the SLAP lesion can be difficult. Although several testing procedures have been developed to evaluate the SLAP lesion, none can be considered completely predictive, nor

Acknowledgements

Acknowledgment: The authors gratefully appreciate Dr. Kay-Hyun Park for his work in the area of graphics in this study.

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Cited by (151)

American Shoulder and Elbow Surgeons SLAP/Biceps Anchor Study Group evidence review: pathoanatomy and diagnosis in clinically significant labral injuries
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Glenoid superior biceps-labral pathology diagnosis, treatment, and outcomes are an evolving area of shoulder surgery. Historically, described as superior labrum anterior posterior (SLAP) tears, these lesions were identified as a source of pain in throwing athletes. Diagnosis and treatments applied to these SLAP lesions resulted in less than optimal outcomes in some patients and a prevailing sense of confusion. The purpose of this paper is to perform a reappraisal of the anatomy, examination, imaging, and diagnosis by the American Shoulder and Elbow Surgeons/SLAP biceps study group. We sought to capture emerging concepts and suggest a more unified approach to evaluation and identify specific needs for future research.
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The Top 50 Most-Cited Papers in the Diagnosis and Management of SLAP Tears
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To identify and characterize the top 50 most-cited articles regarding SLAP tears.
Referencing the methodology of previous citation analyses, varying Boolean searches were performed using the Web of Science database and the search terms yielding the greatest number of results was used. The top 50 most-cited articles were identified and the following data points were gathered from each article: author, institution, country of origin, year of publication, publishing journal, level of evidence, and citation density.
The total number of citations was 7834, with a median of 106 citations. The top 50 list was largely composed of diagnostic level I, II, and III studies (5, 7, and 8 total publications, respectively) and therapeutic level III (6 publications) or level IV (10 publications). Most articles originated from the United States (40). In total, 19 of the top 50 most-cited articles were published in the American Journal of Sports Medicine, followed by Arthroscopy (15) and the Journal of Bone and Joint Surgery (5).
Our analysis demonstrated a correlation with earlier publications being cited more frequently than recent studies. Importantly, the current study found that therapeutic studies in the most cited list were largely level III or level IV evidence. This makes the management of SLAP tears seem anecdotal, with little in the way of high-impact level I or level II therapeutic studies. We must reconsider our current understanding of SLAP tears and their management with more studies that demonstrate a clearer treatment algorithm for these common injuries of the shoulder.
Given the complexity of SLAP tears, this list of the most-cited articles can provide a reference point to better guide practice, resident education, and future areas of orthopaedic research.
The Fifty Most-Cited Articles Regarding SLAP Lesions
2021, Arthroscopy, Sports Medicine, and Rehabilitation
To identify and evaluate the top 50 most-cited articles pertaining to SLAP tears.
The ISI Web of Knowledge database was used to conduct a query for articles pertaining to SLAP tears. Our query was conducted in April 2020 with multiple Boolean operative combinations performed by 2 independent reviewers. Articles on the final list were further reviewed to extract the following data: manuscript title, first author, total citation count, year of publication, citation density since publication, current citation rate since 2013, journal, country of origin, and level of evidence.
Our initial search yielded 2,597 articles. Within this cohort, the top 50 publications pertaining to SLAP tears were identified that met our search criteria. The top article was cited 802 times while the 50th ranked article was cited 46 times. The average number of citations per publication was 131, whereas the average citation density since year of publication was 7.3. No strong correlations were found between citation density and year published. Twelve journals published articles pertaining to SLAP tears, with Arthroscopy accounting for the greatest number (15 articles, 30%). Most articles were graded with a level of evidence (LOE) of IV (n = 24, 48%), followed by review articles without LOE (n = 8, 16%). Only 2 articles achieved an LOE of I (4%). Articles typically addressed the arthroscopic management (n = 11, 22%), whereas anatomy/classification (n =10, 20%), and outcomes (n = 9, 18%) also were reported.
This review provides a quantitative analysis of the most-referenced literature pertaining to SLAP tears. This body of knowledge helps surgeons search for literature regarding these injuries and identify trends regarding SLAP tear research.
This research provides practitioners with an easily accessible and comprehensive collection of the major contributions regarding SLAP tears and offers insight into future areas for research.
Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability
2020, Journal of Shoulder and Elbow Surgery
The literature has reported debatable diagnostic accuracy of clinical provocative tests for a type II superior labral anteroposterior (SLAP) lesion, especially in the context of a type V SLAP (concurrent Bankart and type II SLAP) lesion. This study was conducted to determine whether the investigated provocative tests offer reliable predictive values in the diagnosis of type II SLAP lesions in patients with recurrent anterior glenohumeral (GH) instability.
This prospective case-control study carried out between September 2014 and September 2018 included 51 patients with post-traumatic recurrent anterior GH instability. Patients were prospectively evaluated for type II SLAP lesions by 9 provocative tests: Jobe relocation test, abduction–external rotation test, anterior slide test, biceps load test I, biceps load test II, pain provocation test, labral tension test, crank test, and the O'Driscoll dynamic labral shear test. The results of these tests were compared with findings of diagnostic arthroscopic GH examinations (control).
Statistical analysis revealed the mean age of the studied group to be 26.1 ± 7.56 years, with male predominance (50 patients; 98.04%). Arthroscopic examination revealed a Bankart lesion in isolation and in association with a type II SLAP lesion (ie, a type V SLAP lesion) in 15 (29.4%) and 36 (70.6%) patients, respectively. The anterior slide test yielded the highest positive and lowest negative likelihood ratios (2.91 and 0.52, respectively).
Except for the anterior slide test, which can be validated for the clinical diagnosis of type II SLAP lesions in patients with traumatic recurrent anterior GH instability, the investigated tests offer poor predictive values and should be cautiously used in clinical practice.
Incorporating biomechanical data in the analysis of a university student with shoulder pain and scapula dyskinesis
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^☆: Address correspondence and reprint requests to Seung-Ho Kim, M.D., Ph.D., Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea. E-mail: [email protected]

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Original ArticlesBiceps load test II: A clinical test for SLAP lesions of the shoulder☆

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Glenoid labrum tears related to the long head of the biceps

Am J Sports Med

Arthroscopic labral debridement: A three-year follow-up study

Am J Sports Med

Anatomy, histology, and vascularity of the glenoid labrum: An anatomical study

J Bone Joint Surg Am

Arthroscopic treatment of glenoid labral tears

Am J Sports Med

Original Articles
Biceps load test II: A clinical test for SLAP lesions of the shoulder☆