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A meta-analysis examining clinical test utility for assessing superior labral anterior posterior lesions
Brent B Meserve1, Joshua A Cleland, Thomas R Boucher
1Department of Rehabilitative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. Brent.B.Meserve@hitchcock.org
Background:
The reported accuracy of clinical tests for superior labral anterior posterior lesions is extremely variable. Pooling results from multiple studies of higher quality is necessary to establish the best clinical tests to use.
Hypothesis:
Certain clinical tests are superior to others for diagnosing the presence or absence of a superior labral anterior posterior lesion.
Study Design:
Meta-analysis.
Methods:
A literature search of MEDLINE (1966-2007), CINAHL (1982-2007), and BIOSIS (1995-2007) was performed for (labrum OR labral OR SLAP OR Bankart) AND (shoulder OR shoulder joint OR glenoid) AND (specificity OR sensitivity AND specificity). Identified articles were reviewed for inclusion criteria. Sensitivity and specificity values were recorded from each study and used for meta-analysis.
Results:
Six of 198 identified studies satisfied the eligibility criteria. Active compression, anterior slide, crank, and Speed tests were analyzed using receiver operating characteristic curves. The accuracy of the anterior slide test was significantly inferior to that of the active compression, crank, and Speed tests. There was no significant difference in test accuracy found among active compression, crank, and Speed tests. Between studies, methodological scores did not significantly affect sensitivity and specificity values.
Conclusion:
The anterior slide test is a poor test for detecting the presence of a labral lesion in the shoulder. Active compression, crank, and Speed tests are more optimal choices. Clinicians should choose the active compression test first, crank second, and Speed test third when a labral lesion is suspected.