Superior Labral Anterior Posterior Lesion: Likelihood Ratios

Introduction: aka SLAP lesion. From tearing the superior aspect of the labrum in the glenohumeral joint of the shoulder.

The likelihood ratios of findings for Superior Labral Anterior Posterior Lesion are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive Likelihood Ratio
Finding	Result	+LR	-LR
[ + ] Yergason's Test	+ 0 -	2	0.7
for Proximal Biceps Tendon Tear OR SLAP Lesion In this test, the patient's elbow is flexed to 90 degrees with the thumb up. The examiner grasps the wrist, resisting attempts by the patient to actively supinate the arm and flex the elbow. Pain with this maneuver indicates biceps tendonitis. Study: Arthroscopy. 2004 Mar;20(3):231-6. PMID: 15007311

Negative Findings
Finding	Result	+LR	-LR
[ + ] Anterior Slide Test	+ 0 -	0.4	1.1
Patient stands with hands on hips. One of the examiner's hands is placed over the shouler and the other hand behind the elbow. A force is then applied anteriorly and superiorly, and the patient is asked to push back against the force. The test is positive if pain is localised to the anterosuperior aspect of the shoulder, if there is a pop or a click in that region, or if the maneuver reproduces that patient's symptoms. Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Mimori Test	+ 0 -	10	0
the arm is placed in 90° abduction, the elbow in 90° flexion, and the forearm in maximum supination. To provoke symptoms, the examiner moves the forearm into maximum pronation. NOTE: small study Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585
[ + ] Biceps Load II Test	+ 0 -	22.5	0.1
with the patient supine, the arm is placed in 120° abduction, and the elbow is placed in 90° flexion. The patient is asked to resist the lateral force applied by the examiner. Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585
[ + ] Zaslav Test	+ 0 -	22	0.1
aka internal rotation resistance strength: with the patient standing or sitting, the humerus in 90° abduction and 80° external rotation. The patient is asked to resist an external rotation force applied by the examiner, then to resist an applied internal rotation force. Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585
[ + ] Biceps Load I Test	+ 0 -	41.5	0.2
with the patient supine, the arm is placed in 90° abduction, and the elbow is placed in 90° flexion. The patient is asked to resist the lateral force applied by the examiner. Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] Compression Rotation test	+ 0 -	1	1
Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585
[ + ] Speed Test	+ 0 -	0.8	1.1
The patient's elbow is flexed 20 to 30 degrees with the forearm in supination and the arm in about 60 degrees of flexion. The examiner resists forward flexion of the arm while palpating the patient's biceps tendon over the anterior aspect of the shoulder. NOTE: odds ratio CI includes 1! Study: Br J Sports Med. 2008 Feb;42(2):80-92. PMID: 17720798
[ + ] Crank Test	+ 0 -	1	1
The patient's shoulder is abducted 90 degrees and slowly internally rotated while a gentle axial load is applied through the glenohumeral joint. The test is considered positive if the patient reports pain, catching, or grinding in the shoulder. Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585
[ + ] O'Brien Test	+ 0 -	1	1
aka active compression test: The patient's shoulder is held in 90 degrees of forward flexion, 30 to 45 degrees of horizontal adduction and maximal internal rotation. The examiner grabs the patient's wrist and resists the patient's attempt to horizontally adduct and forward flex the shoulder. Study: JAMA. 2004 Oct 27;292(16):1989-99. PMID: 15507585