Special physical examination tests for superior labrum anterior posterior shoulder tears are clinically limited and invalid: a diagnostic systematic review

J Clin Epidemiol. 2009 May;62(5):558-63. doi: 10.1016/j.jclinepi.2008.04.010. Epub 2009 Feb 20.


Objective: The diagnosis of a superior labrum anterior posterior (SLAP) lesion through physical examination has been widely reported in the literature. Most of these studies report high sensitivities and specificities, and claim to be accurate, valid, and reliable. The purpose of this study was to critically evaluate these studies to determine if there was sufficient evidence to support the use of the SLAP physical examination tests as valid and reliable diagnostic test procedures.

Study design and setting: Strict epidemiologic methodology was used to obtain and collate all relevant articles. Sackett's guidelines were applied to all articles. Confidence intervals and likelihood ratios were determined.

Results: Fifteen of 29 relevant studies met the criteria for inclusion. Only one article met all of Sackett's critical appraisal criteria. Confidence intervals for both the positive and negative likelihood ratios contained the value 1.

Conclusion: The current literature being used as a resource for teaching in medical schools and continuing education lacks the validity necessary to be useful. There are no good physical examination tests that exist for effectively diagnosing a SLAP lesion.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Physical Examination / methods
  • Physical Examination / standards*
  • Predictive Value of Tests
  • Reproducibility of Results
  • Shoulder Injuries*
  • Wounds and Injuries / diagnosis