Diagnostic Accuracy of Clinical Testing for Superior Labral Anterior Posterior Lesions: A Systematic Review

STUDY DESIGN: Systematic literature review. OBJECTIVES:  To conduct a systematic review of case series and clinical trials investigating the diagnostic accuracy of clinical tests for superior labral anterior posterior (SLAP) lesions. BACKGROUND: Primary contact practitioners are often presented with shoulder problems and use a battery of clinical tests to reach a diagnosis. Early detection of SLAP pathology may lead to more optimal interventions and better outcomes for patients. METHODS AND MEASURES: The OVID search interface was utilized with MEDLINE, AHMED, CINAHL, and SPORTDiscus databases searched from 1996-2006. Studies were retrieved that included patients with shoulder pain who underwent at least 1 clinical shoulder test for SLAP lesions. For an article to be included in this review, the results of the clinical tests needed to be compared with findings on arthroscopy. Quality of the manuscripts included in this review were rated using the QUADAS appraisal tool so comparisons could be made across studies. RESULTS: Seventeen published manuscripts fit the inclusion/exclusion criteria and were used for this review. Eight studies were found to be of high quality. Within these 8 studies, Lui et al²⁷ reported high diagnostic accuracy values for the Crank test (sensitivity 91% (95% confidence intervals 76-97), specificity 93% (95% confidence intervals 79-88), + likelihood ratio 13.6 (95% confidence intervals 3.6-52.1), and - likelihood ratio 0.1 (95% confidence intervals 0.0-0.3). The study by Myers et al³⁵ on the Resisted Supination External Rotation Test also scored high on the QUADAS and reported diagnostic accuracy values of 83% (66-92), 82% (52-95), 4.6 (1.3-16.1) and 0.20 (0.1-0.5) respectively. Of significance is the fact that the majority of papers reporting highly accurate clinical diagnostic tests, were of low quality with the results not supported by other authors. CONCLUSION: It appears no single test is sensitive or specific enough to determine the presence of a SLAP lesion accurately. Further research is required to determine whether sub-grouping of patients by mechanism of injury or the type of SLAP lesion, may improve diagnostic accuracy. Determining the diagnostic accuracy of a combination of 2 or more tests is also needed.

J Orthop Sports Phys Ther., Epub 22 February 2008, doi:10.2519/jospt.2008.2676

The authors conduct a systematic review of case series and clinical trials investigating the diagnostic accuracy of clinical tests for superior labral anterior posterior (SLAP) lesions.