Which test is best used to detect a SLAP lesion?

Which test is best used to detect a SLAP lesion?

• A. Hawkins-Kennedy
• B. O'Brien's test
• C. Speeds test
• D. Ludington's test

Answer: (B)

Testing for SLAP lesions relies on provocative maneuvers that specifically load the superior labrum and the long head of the biceps tendon. O’Brien’s test does just that: with the arm positioned in about 90 degrees of flexion, a slight adduction, and the forearm internally rotated (thumb toward the floor), the examiner applies a downward force while the patient resists. A positive sign is pain generated in the shoulder joint (not the AC joint) in this position. The test is then repeated with the forearm supinated (palm up). If the pain diminishes or disappears with the supination, it points toward a SLAP lesion, because the biceps tendon and superior labrum are stressed in the first position but relieved when the forearm is supinated. This makes O’Brien’s test particularly helpful for distinguishing intra-articular labral pathology from other shoulder issues. Other tests listed target different structures: Hawkins-Kennedy emphasizes subacromial impingement; Speeds tests the long head of the biceps tendon for tendinopathy; Ludington’s test assesses biceps tension. While those can be positive in various shoulder problems, they are not as specifically targeted to a superior labral tear as O’Brien’s test.

Testing for SLAP lesions relies on provocative maneuvers that specifically load the superior labrum and the long head of the biceps tendon. O’Brien’s test does just that: with the arm positioned in about 90 degrees of flexion, a slight adduction, and the forearm internally rotated (thumb toward the floor), the examiner applies a downward force while the patient resists. A positive sign is pain generated in the shoulder joint (not the AC joint) in this position. The test is then repeated with the forearm supinated (palm up). If the pain diminishes or disappears with the supination, it points toward a SLAP lesion, because the biceps tendon and superior labrum are stressed in the first position but relieved when the forearm is supinated. This makes O’Brien’s test particularly helpful for distinguishing intra-articular labral pathology from other shoulder issues.

Other tests listed target different structures: Hawkins-Kennedy emphasizes subacromial impingement; Speeds tests the long head of the biceps tendon for tendinopathy; Ludington’s test assesses biceps tension. While those can be positive in various shoulder problems, they are not as specifically targeted to a superior labral tear as O’Brien’s test.