Original Article
The Passive Distraction Test: A New Diagnostic Aid for Clinically Significant Superior Labral Pathology

https://doi.org/10.1016/j.arthro.2009.04.070Get rights and content

Purpose

The purpose of this report is to present a new provocative maneuver, the passive distraction test (PDT), as an examination tool to be used in the evaluation of patients thought to have a SLAP lesion and to compare its accuracy, precision, and reproducibility alone and in conjunction with previously published maneuvers.

Methods

A retrospective analysis of 319 consecutive arthroscopies performed between May 2001 and November 2003 was performed. A total of 65 cases were excluded, 53 because of limitation of elevation to less than 150° or pain in the starting test position and 12 who had previous shoulder procedures performed by the senior author, leaving 254 cases for review. A thorough history was obtained and a thorough physical examination performed with a focus on the involved shoulder including specific provocative maneuvers for the clinical diagnosis of a SLAP lesion. The active compression test, the anterior slide test, and the PDT were used to clinically diagnose a SLAP lesion. The results from the 3 provocative maneuvers were compared with the arthroscopic findings to determine the sensitivity, specificity, negative predictive value (NPV), and positive predictive value of each test alone and in a logical combination.

Results

Of 254 shoulder arthroscopies, 61 had a clinically significant SLAP lesion, for an incidence of 24%. The sensitivity and specificity for the PDT were 53% and 94%, respectively, with an NPV of 87% and positive predictive value of 72%. In combination, the PDT and the active compression test yielded an NPV of 90.5%.

Conclusions

The PDT can be used alone or in combination to aid in the clinical evaluation and diagnosis of a SLAP lesion.

Level of Evidence

Level IV, retrospective, diagnostic, sensitivity-specificity study.

Section snippets

Methods

A retrospective analysis of 319 shoulder arthroscopies performed between May 2001 and November 2003 was performed. All patients had presented during the study period for evaluation of shoulder pain and/or dysfunction. A complete shoulder history was taken from all patients. This included a detailed history of the mechanism of injury or onset of symptoms, previous diagnostic tests, current symptoms, hand dominance, occupation, athletic activities, previous injuries, surgery, and response to

Results

A total of 246 patients (254 shoulders) were evaluated and their data analyzed for inclusion in this study. Of the 254 shoulder arthroscopies, 61 (24%) had a clinically significant type II, III, or IV SLAP lesion. Arthroscopic findings occurring alone and concomitant with SLAP lesions included rotator cuff tears, Bankart lesions, subacromial impingement, and biceps tendon pathology (Table 2, Table 3). Twenty patients were found to have an isolated SLAP tear. In this population, when the PDT was

Discussion

Lesions of the superior labrum have been difficult to diagnose based on clinical evaluation.4, 6, 7, 17 Comparison of recent reports shows great variability in the sensitivity, specificity, PPV, and NPV for the most commonly performed SLAP tests.20, 22, 26, 27 Recently, we have used the PDT in the clinical evaluation for SLAP lesions.29 It is postulated that this maneuver as described rotates the radial tuberosity, placing traction on the biceps, which in turn tensions the proximal long head of

Conclusions

The PDT can be used alone or in combination to aid in the clinical evaluation and diagnosis of a SLAP lesion.

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    The authors report no conflict of interest.

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