A clinical test for superior glenoid labral or 'SLAP' lesions

Objective: To describe a clinical test associated with unstable lesions of the superior glenoid labrum-long head biceps tendon origin, or SLAP (superior labrum 'anterior to posterior). Design: Description of a newly discovered clinical sign that correlated with SLAP pathology. Retrospective review of 66 consecutive arthroscopically confirmed SLAP lesions to determine the sensitivity of the SLAPprehension test. Setting: Orthopedic sports medicine clinics with an emphasis on shoulder problems. Patients: Patients with shoulder pain and arthroscopically verified lesions of the superior glenoid labrum and conjoined long head biceps tendon. Intervention: Shoulder arthroscopy and in some cases arthroscopic SLAP lesion repair. Outcome Measures: Nonapplicable. Results: The SLAPprehension test involves cross chest adduction (horizontal flexion) of the affected shoulder with the elbow extended and forearm pronated. A positive maneuver produces either apprehension, pain referable to the bicipital groove, and an audible or palpable click. The test is repeated with the forearm supinated, which must cause diminution of the pain. Mechanically, elbow extension and forearm pronation places traction on the long head biceps tendon. When anterior scapular protraction is limited by the clavicle, further adduction entraps the unstable biceps tendon and superior glenoid labrum between the glenoid fossa and humeral head. Forearm supination decreases traction on the long head biceps tendon and allows for reduction of the unstable labrum complex with lessening of the pain. A retrospective chart review of 66 consecutive arthroscopically verified shoulders with SLAP lesions revealed the SLAPprehension test to be 87.5% sensitive for unstable SLAP lesions. Conclusions: The SLAPprehension test is helpful in the clinical evaluation of patients with unstable superior glenoid labrum lesions whose symptoms are often confused and overlap with those of shoulder impingement or acromioclavicular arthrosis.