A New SLAP Test: The Supine Flexion Resistance Test

Authors: Nina Ebinger, Petra Magosch, Sven Lichtenberg, Peter Habermeyer

References: Arthroscopy: The Journal of Arthroscopic and Related Surgery - May 2008 (Vol. 24, Issue 5, Pages 500-505

Purpose: This study describes a new test to detect SLAP lesions. The sensitivity, specificity, and positive and negative predictive values with respect to the diagnosis of a SLAP lesion were determined in comparison to Speed's test and the O'Brien test.

Methods: One hundred fifty patients presenting for arthroscopic surgery with persisting pain or functional disability of the shoulder underwent a complete shoulder examination. All patients underwent Speed's test, the O'Brien test, and the new supine flexion resistance test. The clinical results of the tests were correlated with the presence of a SLAP lesion by direct arthroscopic visualization.

Results: The supine flexion resistance test had a sensitivity of 80% and a specificity of 69%, whereas Speed's test and the O'Brien test had sensitivities of 60% and 94%, respectively, and specificities of 38% and 28%, respectively. Regarding isolated SLAP lesions, the supine flexion resistance test was highly sensitive, with a sensitivity of 92% (58% for Speed's test and 75% for the O'Brien test). For isolated tears of the supraspinatus, the specificity of the supine flexion resistance test was 75% (14% for Speed's test and 17% for the O'Brien test).

Conclusions: Compared with the O'Brien test and Speed's test, the supine flexion resistance test proves to be more specific, with a specificity of 69% for the whole study population (28% for the O'Brien test and 38% for Speed's test) and with a specificity of 75% for the group of patients with isolated supraspinatus lesions (17% for the O'Brien test and 14% for Speed's test). The new test is a useful and effective test for detecting type II SLAP lesions. The high specificity enables the elimination of false-positive results of other clinical tests that are more sensitive but not specific.

Level of Evidence: Level II, development of diagnostic criteria with consecutive patients and universally applied gold standard.


"The supine flexion resistance test is performed with the patient in the supine position. The patient is asked to rest the arm above the head in full elevation, with the forearm resting on a pallet with the palm facing upward. The examiner is positioned adjacent to the patient on the same side as the examined shoulder and grasps the patient's arm just distal to the elbow. Then the patient is asked to perform a forward flexion of the arm as if simulating a throwing motion. The test is considered positive only if pain is elicited deep inside the shoulder joint or at the dorsal aspect of the shoulder along the joint line during the resisted movement. "

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