Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleThe Passive Distraction Test: A New Diagnostic Aid for Clinically Significant Superior Labral Pathology
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.
References (32)
- et al.
Glenoid labrum tears related to the long head of the biceps
Am J Sports Med
(1985) - et al.
SLAP lesions of the shoulder
Arthroscopy
(1990) - et al.
Current concepts in the recognition and treatment of superior labral (SLAP) lesions
J Orthop Sports Phys Ther
(2005) - Romeo AA, Cole B, Verma M. SLAP lesions. Presented at the Arthroscopy Association of North America Fall Course, New...
- et al.
Disorders of the superior labrum: Review and treatment guidelines
Clin Orthop Relat Res
(2002) - et al.
SLAP lesions: Current concepts
Am J Orthop
(2001) - et al.
Superior labral lesions in the shoulder: Pathoanatomy and surgical management
J Am Acad Orthop Surg
(1998) - et al.
Clinical features of the different types of SLAP lesions: An analysis of one hundred and thirty-nine casesSuperior labrum anterior posterior
J Bone Joint Surg Am
(2003) - et al.
Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: Comparison with arthroscopic findings
Arthroscopy
(2004) - et al.
SLAP lesions: A retrospective multicenter study
Arthroscopy
(1998)
The disabled throwing shoulder: Spectrum of pathologyPart I: Pathoanatomy and biomechanics
Arthroscopy
Shoulder injuries in overhead athletesThe “dead arm” revisited
Clin Sports Med
The peel-back mechanism: Its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation
Arthroscopy
SLAP lesions in the overhead athlete
Orthop Clin North Am
Superior labrum-biceps tendon complex lesions of the shoulder
Am J Sports Med
The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality
Am J Sports Med
Cited by (22)
Nonoperative Treatment of the Biceps-Labral Complex
2023, Physical Medicine and Rehabilitation Clinics of North AmericaPhysical examination of the shoulder
2014, Journal of Hand SurgeryCitation Excerpt :Although the authors reported the test to have good reliability,40 the crank test has not been shown to be reliable in other studies.33,34,36 Several other tests have been described to evaluate for a superior labral anterior posterior tear including the pain provocative test,41 biceps load I test,42 biceps load II test,43 the resisted supination external rotation test,36 dynamic labral shear test (O'Driscoll test) (Cheung EV and O'Driscoll SW, presented at the American Association of Orthopaedic Surgeons annual meeting, 2007), modified dynamic labral shear test,32 passive distraction test,44 and labral tension test.38 Description of these individual tests is beyond the scope of this article.
Failed Superior Labrum Anterior Posterior and Proximal Biceps Surgery
2012, Operative Techniques in Sports MedicineCitation Excerpt :There are a series of special tests that have been designed to attempt to clinically evaluate for proximal biceps pathology with varying degrees of specificity and sensitivity. Many clinicians have found a battery of 2 to 3 tests, which in their own hands, are the most sensitive for the evaluation of proximal biceps pathology, such as superior labral tears anteroposterior, bicep tendinitis, and instability.8-10 Standard radiographs of the shoulder are done to primarily evaluate for concomitant pathology, such as rotator cuff tear arthropathy, calcific tendinitis, and acromioclavicular or glenohumeral arthrosis.
Superior Labrum Anterior to Posterior (SLAP) lesions of the shoulder
2011, Orthopaedics and TraumaCitation Excerpt :The scapula is stabilized and an antero-superiorly directed axial load is applied to the humerus to reproduce pain. The sensitivity and specificity vary from 8 to 78%33,43,44 and 70 to 98%33,35,44 respectively. Kim’s Biceps Load Test I: the biceps is contracted against resistance with the shoulder placed in 90° abduction, maximal external rotation and the forearm supinated.45
Physical Examination Maneuvers for SLAP Lesions: A Systematic Review and Meta-analysis of Individual and Combinations of Maneuvers
2023, American Journal of Sports MedicineDifferential Diagnosis of Shoulder Pain in Physical Therapy: An Algorithm for Clinical Reasoning
2022, Lecture Notes in Networks and Systems
The authors report no conflict of interest.