From the Guidelines
A SLAP (Superior Labrum Anterior to Posterior) lesion exam involves several specific physical tests to evaluate for tears in the superior labrum of the shoulder, but definitive diagnosis typically requires MRI arthrography, as physical examination alone has limitations 1.
Physical Examination Tests
The most reliable tests include:
- O'Brien's test, where the patient's arm is positioned at 90 degrees of forward flexion, 10-15 degrees of adduction, and internal rotation while the examiner applies downward pressure; pain that improves when the palm is supinated suggests a SLAP lesion.
- The Crank test involves elevating the arm to 160 degrees with the elbow flexed while applying axial load and rotating the humerus.
- Other useful tests include the Active Compression test, Speed's test, and the Anterior Slide test. These tests have varying sensitivity and specificity, so multiple positive tests increase diagnostic confidence.
Importance of MRI Arthrography
MRI arthrography is considered the gold standard for imaging traumatic shoulder pain and has been shown to have high sensitivity for detection of labral injury, ranging from 86% to 100% 1. When performing these tests, it's essential to compare findings with the unaffected shoulder and consider the patient's history of overhead activities or trauma, as these are common causes of SLAP lesions. Pain with overhead activities and mechanical symptoms like catching or popping are typical complaints that should prompt these specific examination maneuvers. The use of MRI arthrography is recommended for patients suspected of having a SLAP lesion, as it provides a more accurate diagnosis compared to physical examination alone 1.
From the Research
SLAP Lesion Exam
- The diagnosis of SLAP lesions can be challenging, and physical examination maneuvers are often used to aid in diagnosis 2.
- Common physical examination maneuvers used to diagnose SLAP lesions include the O'Brien, speed, Yergason, anterior slide, crank, Jobe, dynamic labral shear, Kim 2, and biceps groove tenderness tests 2.
- The O'Brien and crank test combination was found to be the most sensitive 2-test combination in both parallel and series, while the Yergason and anterior slide test combination was the most specific 2-test combination in parallel and series 2.
- Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) can also be used to diagnose SLAP lesions, but their accuracy has been found to be lower than previously reported, with a sensitivity of 66% and specificity of 77% for MRI, and a sensitivity of 80% and positive predictive value of 29% for MR arthrography 3.
- The treatment of SLAP lesions depends on various factors, including the type of lesion, age of patient, concomitant lesions, and functional requirements, as well as sport activity level of the patient 4, 5, 6.
- Nonoperative management is often the first-line treatment for most young, active patients without history of trauma, mechanical symptoms, and/or demand for overhead activities, and may include rest, avoidance of aggravating factors, injections, and physical therapy 4.
- Operative treatment options include arthroscopic repair, biceps tenodesis, and biceps tenotomy, and the choice of treatment depends on the individual patient's needs and circumstances 4, 5, 6.