Physical examination tests are not valid for diagnosing SLAP tears: a review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Diagnostic Accuracy Studies

Background:

• Superior labrum anterior posterior (SLAP) lesions are common shoulder injuries, particularly in athletes.
• Accurate diagnosis of SLAP lesions is crucial for appropriate treatment and patient outcomes.
• Physical examination is often the initial diagnostic tool for suspected SLAP lesions.

Discussion:

• This systematic review critically evaluated the evidence for physical examination procedures in diagnosing SLAP lesions.
• Methodological quality of studies varied significantly, with only one study meeting all rigorous criteria.
• The accuracy of commonly used tests like Speed's and Yergason's was found to be poor.

Key Insights:

• Speed's test demonstrated low sensitivity (32%) and Yergason's test showed low sensitivity (43%), indicating frequent missed diagnoses.
• Specificities for Speed's (79%) and Yergason's (75%) tests were moderate, but likelihood ratios could not reliably rule in or rule out SLAP lesions.
• Most other studies evaluating SLAP lesion physical examination tests suffered from significant methodological shortcomings, limiting their validity.

Outlook:

• Further high-quality research with robust methodologies is needed to establish reliable physical examination tests for SLAP lesions.
• The current evidence suggests that physical examination alone is insufficient for definitive SLAP lesion diagnosis.
• Clinicians should consider advanced imaging or arthroscopy for definitive diagnosis when SLAP lesions are suspected.