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An Evaluation of the Provocative Tests for Superior Labral Anterior Posterior Lesions

Michael Andrew Parentis, MD^*,, Ronald E. Glousman, MD, Karen S. Mohr, PT, SCS and Lewis A. Yocum, MD

From The Knee Center of Western New York, Amherst, New York, and the Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California

^* Address correspondence to Michael Andrew Parentis, MD, 100 Corporate Parkway, Suite 112, Amherst, NY 14226 (e-mail: mparentis{at}adelphia.net).

Background: Although our understanding of superior labral anterior posterior lesions has grown, the physical diagnosis remains imperfect.

Study Design: Cohort study (diagnostic); Level of evidence, 2.

Purpose: To determine the most effective provocative maneuver with which to diagnose superior labral anterior posterior lesions.

Methods: A series of 132 consecutive patients scheduled to undergo diagnostic shoulder arthroscopy were examined preoperatively over a 6-month period, and the final diagnosis in each case was made arthroscopically. The following assessments were included: active compression (O’Brien), anterior slide, pain provocation, crank, Jobe relocation, Hawkins, Neer, Speed, and Yergason tests.

Results: The most sensitive diagnostic tools for type II superior labral lesions were the active compression, Hawkins, Speed, Neer, and Jobe relocation tests. When type I and type II lesions were combined, the results were similar. However, none of the sensitive tests were specific for either type I or type II lesions.

Conclusions: The authors’ results contradict the current literature regarding provocative testing for both stable and unstable superior labral lesions. There is no single maneuver that can accurately diagnose superior labral anterior posterior lesions; arthroscopy remains the standard by which to diagnose such lesions.

Key Words: shoulder • superior labral anterior posterior (SLAP) lesions • tear • arthroscopy • diagnostic

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