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Clinical assessment of three common tests for superior labral anterior-posterior lesions
Edward G McFarland1, Tae Kyun Kim, Richard M Savino
1Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
Background:
Three tests (active compression, anterior slide, and compression rotation) are commonly used to diagnose superior labral anterior-posterior lesions.
Hypothesis:
We hypothesized that the accuracy, sensitivity, and specificity for these tests was less than that previously reported and that a click in the shoulder during manipulation was not specific for the study lesion.
Study Design:
Case-control study.
Methods:
The three tests were performed on 426 patients who subsequently underwent shoulder arthroscopy. The results of physical examination were compared with the arthroscopic findings and analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy.
Results:
At arthroscopy, 39 patients had type II to IV lesions (study group); the remaining 387 patients had type I lesion or no lesion (control group). The incidences of positive results were not statistically different between the groups (P > 0.05). Our findings were as follows: most sensitive test, active compression (47%); most specific test, anterior slide (84%); highest positive predictive value, active compression (10%); highest overall accuracy, anterior slide test (77%); lowest overall accuracy, active compression test (54%). The presence of a click and the location of the pain were not reliable diagnostic indicators.
Conclusions:
The results of such tests should be interpreted with caution when considering surgery for a possible superior labral anterior-posterior lesion.
