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Biceps Load Test 2

The biceps load 2 was specifically designed to evaluate SLAP lesions.

Test

The patient is tested in supine. The arm is abducted to 120°, externally rotated maximally, elbow in 90° flexion and forearm supinated. If this test position reproduces pain then perform active elbow flexion against resistance.

Positive

The active elbow flexion component of the test should increase pain (or elicit pain) reproduced in the first part of the test. The test is negative if pain is not elicited on active elbow flexion, or if it is unchanged or decreased.

The basis of the test is that the abduction/external rotation component changes the relative direction of the biceps tendon in a position obliquely angled to the postero-superior labrum. The resultant contraction of the biceps increases the pain generated by increasing tension on the superior labrum that is already peeled off the glenoid margin in abduction/external rotation.

Research

Prospective double blind study of 127 patients.

Biceps Load 2 was positive in 38 patients - 35 had a type 2 SLAP

Test was negative in 89-

  • 3 of these had a normal superior labrum
  • 4 had a type 2 SLAP
  • 85 had subacromial impingement or a rotator cuff tear
Sensitivity   Specificity   PPV   NPV
89.7%   96.9%   92.1%   95.5%

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