SLAP Lesions: Diagnosing Shoulder Injury

SLAP Lesions: Diagnosing Shoulder Injury

Dr. GJohn Mullen Blog, Dr. John Mullen, Injuries Leave a Comment

Background On SLAP Lesions 

Superior labral anterior posterior (SLAP) lesion is a pathology where the superior labrum, anterior and posterior biceps anchor detach. This detachment leads to instability, pain, and functional decline.

In swimming, this injury is one of many shoulder injuries contributing to shoulder pain. The clinical diagnosis of a SLAP lesion is difficult, especially since the clinical tests to determine this injury are questioned. Even with questionable accuracy, the clinical tests are often used to get imaging of the shoulder.

The purpose of the study was to evaluate frequently used tests and define the diagnostic accuracy of each test for the presence of an isolated SLAP lesion and a SLAP lesion with concomitant findings, as well as determine each test’s value toward surgical decision making.

What was done

Eighty-seven patients were included over a two year period with an MRI confirming a SLAP, received all 5 clinical tests, and had surgical confirmation of a diagnosis. Participants were consecutively selected at an orthopedic clinic with various shoulder dysfunctions. Specific shoulder pathologies were excluded from the study, included radiculopathy, adhesive capsulitis, etc. Then, a physician examined each patient using the following tests:

  1. Active compression/O’Brien’s test
  2. Biceps Load II test (Kim Test II)
  3. Dynamic Labral Shear test (O’Driscoll’s test)
  4. Speed’s test
  5. Labral Tension test

All of the tests were performed by the same physician.


The strongest clinical test was the Biceps Load II test and the Labral Tension Test. In nearly all cases, a negative finding was more compelling than a positive finding. However, none of the five tests were overtly diagnostic or was useful in ruling in or out a SLAP diagnosis. When all five tests were positive, a SLAP lesion was unable to be determined. When all tests were negative, the ability to rule out a SLAP lesion was possible.


Previous studies have suggested that clinical tests have difficulty diagnosing a SLAP lesion. This study suggests that each of the five stand-alone tests and clusters of tests provide minimal to no value in the diagnosis of a SLAP lesion, whether a SLAP-only lesion or a SLAP lesion with or without a concomitant finding reference. The diagnostic accuracy of stand-alone clinical tests is typically poor when used alone. The combination of subjective history and other clinical findings. A SLAP is a complex problem typically with additional complications.

Practical Implication

When attempting to diagnosis a SLAP lesion, no stand-alone test is able to accurately diagnose a SLAP lesion. Therefore, diagnostic clinicians must be cautious when using these tests as a means for diagnosis.


  1. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg. 2012 Jan;21(1):13-22.

Originally Posted June 2012

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