Clinical assessment of superior glenoid labral lesions: a systematic review

Superior labral anterior posterior (SLAP) lesions of the glenoid have proven difficult to diagnose clinically. SLAP-lesion-specific physical examination tests have been developed to improve clinical acumen. Initial reported performance of these tests has not been reproduced by independent investigation. We hypothesized SLAP-specific physical examination tests could not provide a definitive diagnosis of a SLAP lesion. We further intended to elucidate factors responsible for the variable performance of SLAP-specific tests. A review of the literature through Medline and Embase database searches was conducted. All studies with level of evidence of III or better involved in the reporting of diagnostic accuracy of SLAP-specific physical examination tests were included and reviewed. Each instance of independent evaluation of a SLAP-specific examination showed poorer examination performance than in the originating study. Considerable variability existed between independent evaluations of a given SLAP-specific examination as well. We concluded SLAP-specific physical examination results cannot be used as the sole basis of a diagnosis of a SLAP lesion. Differences in patient populations between studies and the accompanying differences in SLAP lesion prevalence and comorbid conditions played the greatest role in test result variance.