The resisted supination external rotation test a new test for the diagnosis of superior labral anterior posterior lesions

Purpose: To evaluate a new clinical test, the resisted supination external rotation test, for the diagnosis of superior labral anterior posterior lesions of the shoulder. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Forty athletes (average age, 23.9 years) with activity-related shoulder pain were enrolled in the study. The patients underwent 3 different tests designed specifically to detect superior labral anterior posterior lesions (the resisted supination external rotation test, the crank test, and the active compression test); the tests were performed in a random order on the affected shoulder. The results of the tests were compared with arthroscopic findings. Results: Out of 40 athletes, 29 (72.5 %) had superior labral anterior posterior tears. The resisted supination external rotation test had the highest sensitivity (82.8 %), specificity (81.8 %), positive predictive value (92.3 %), negative predictive value (64.3 %), and diagnostic accuracy (82.5 %) of all tests performed. Conclusion: By re-creating the peel-back mechanism, the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests designed to diagnose superior labral anterior posterior tears in overhead-throwing athletes. By using this test in the context of a thorough clinical history and physical examination, lesions of the superior labrum can be more reliably diagnosed.