This study introduced a physical exam test for superior labral (SLAP) tears in throwing athletes. The test compares external rotation pain in the apprehension position with the forearm pronated versus supinated. Results were checked against MR arthrography in all 32 patients and arthroscopy in 15.
When you evaluate a throwing athlete with shoulder pain, put the arm in the apprehension position at 90 to 100 degrees of abduction and external rotation, then ask whether pain is worse with the forearm pronated or supinated. Worse pain in pronation points to a type II SLAP tear. Pronation lengthens the biceps and increases long head tension, pulling on the detached labral anchor.
This test was more sensitive than the crank test (100% vs 83%), which matters because the crank test relies on a click that small detachments may not produce. Know the limits. A positive test can also reflect biceps tenosynovitis, so it is not specific to the labrum, and it will miss type I fraying lesions.
Use it as a screening maneuver, then confirm with MR arthrography, which matched arthroscopy in every case here.
This study introduced a physical exam test for superior labral (SLAP) tears in throwing athletes. The test compares external rotation pain in the apprehension position with the forearm pronated versus supinated. Results were checked against MR arthrography in all 32 patients and arthroscopy in 15.
When you evaluate a throwing athlete with shoulder pain, put the arm in the apprehension position at 90 to 100 degrees of abduction and external rotation, then ask whether pain is worse with the forearm pronated or supinated. Worse pain in pronation points to a type II SLAP tear. Pronation lengthens the biceps and increases long head tension, pulling on the detached labral anchor.
This test was more sensitive than the crank test (100% vs 83%), which matters because the crank test relies on a click that small detachments may not produce. Know the limits. A positive test can also reflect biceps tenosynovitis, so it is not specific to the labrum, and it will miss type I fraying lesions.
Use it as a screening maneuver, then confirm with MR arthrography, which matched arthroscopy in every case here.