Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle.

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Abstract

[Indexed for MEDLINE] 10. J Shoulder Elbow Surg. 2012 Jan;21(1):13-22. doi: 10.1016/j.jse.2011.07.012. Epub 2011 Oct 28. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. Cook C(1), Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Author information: (1)Division of Physical Therapy, Walsh University, North Canton, OH, USA. ccook@walsh.edu Erratum in J Shoulder Elbow Surg. 2012 May;21(5):707. Comment in J Shoulder Elbow Surg. 2012 Sep;21(9):e16-7. doi: 10.1016/j.jse.2012.05.027. J Shoulder Elbow Surg. 2012 Dec;21(12):e23-4. doi: 10.1016/j.jse.2012.08.006. BACKGROUND: The clinical diagnosis of a superior labral anterior posterior (SLAP) tear is extremely challenging. Most studies that advocate selected tests have errors in study design or significant bias, or both. The purpose of this study was to identify the diagnostic utility of the Active Compression/O'Brien's test, Biceps Load II test, Dynamic Labral Shear test (O'Driscoll's test), Speed's test, and the Labral Tension test when diagnosing isolated SLAP lesions (SLAP-only) and a SLAP lesion with concomitant disorders (eg, rotator cuff tear), as stand-alone and clustered tests, with diagnostic confirmation by arthroscopic surgery. MATERIALS AND METHODS: This diagnostic accuracy study was a case-based, case-control design that included 87 individuals with variable shoulder pathology. RESULTS: Of the 5 tests, only the Biceps Load II test demonstrated utility in identifying patients with a SLAP-only lesion, with a positive predictive value of 26 (95% confidence limits [CL], 18, 31), negative predictive value of 93 (95% CL, 84, 97), positive likelihood ratio of 1.7 (95% CL, 1.1, 2.6), and negative likelihood ratio of 0.39 (95% CL, 0.14, 0.91). No tests demonstrated diagnostic utility when diagnosing any SLAP lesion, including those with concomitant diagnoses. No clusters demonstrated better diagnostic accuracy than stand-alone findings. CONCLUSION: There are a number of potential reasons for the poor utility in the 5 test findings. The heterogeneous sample included patients with a variety of shoulder disorders. The study was organized using very strict methodologic controls that should reduce the risk of bias, which normally overinflates the accuracy of a specific tool. The findings may truly reflect the stand-alone, diagnostic utility of the 5 tests, suggesting when used alone provides little usefulness toward decision making of the diagnostic clinician. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved. DOI: 10.1016/j.jse.2011.07.012