EVIDENCE BASED PRACTICE REVIEW
Title: Identifying SLAP lesions: A meta-analysis of clinical tests and exercise in clinical reasoning
Reference: David M. Walton and Jackie Sadi. Physical Therapy in Sport 9 (2008) 167–176
Aims: The authors aim to identify all published accounts of diagnostic accuracy for clinical tests of Superior Labral Antero-Posterior (SLAP) lesion of the shoulder, and assess the pooled positive likelihood ratio (PLR) of the identified tests.
Design: Systematic review and meta-analysis.
The authors underwent a comprehensive search strategy of databases to identify appropriate articles for inclusion. The methodological quality of included studies was evaluated prior to inclusion.
The studies that met the inclusion criteria were included for meta-analysis. As stated above, the authors chose to calculate the positive likelihood ratio (PLR) of the clinical tests as they felt it was the most clinically relevant and useful. For those of you a bit rusty on your statistics, there is a simple explanation here .
Simply speaking, a PLR of 2 – 5 represents a small change in the probability that a condition exists given a positive results. A PLR of 5 – 10 indicates a moderate shift and > 10 indicates a large shift. Therefore, the higher the PLR the more clinically useful or indicative a positive result becomes.
Seven studies and five clinical tests met the final inclusion criteria. These clinical tests and their pooled PLR (95% CI) are discussed below
1. O’Brien’s Active Compression Test
Pooled PLR = 1.07 (0.83 to 1.38)
2. The Crank Test
Pooled PLR = 1.51 (0.62 to 3.68)
3. Jobe’s Relocation Test
Pooled PLR = 1.13 (0.89 to 1.44)
4. Speed’s Test
Pooled PLR = 1.12 (0.78 to 1.61)
5. Yergason’s Test
Pooled PLR = 2.29 (1.21 to 4.33)
The authors suggest that given these results Yergason’s Test is the only clinical test that demonstrates a clinically significant PLR for the diagnosis of SLAP lesions.
The authors have identified a number of limitations to this research. Firstly, the methodological quality of the included studies was generally low. This will impact the confidence with which we can interpret these results. Also, an inclusion criteria for a clinical test was that it must have 3 data points i.e. have been assessed 3 times. Therefore, clinical tests with acceptable diagnostic accuracy shown in one or two studies were excluded. For the sake of completeness, the tests that fall into this category are shown below:
The Resisted Supination/External Rotation Test
PLR: 4.55 (not included in this study)
The Biceps Load Test I and II
Mimori’s Pain Provocation Test: described here.
This study identifies the importance of diagnostic accuracy during the objective examination of the athlete with a shoulder injury. If SLAP lesion appears on your list of differential diagnoses then few clinical tests will effectively improve your ‘post-test odds’. This study identifies only a positive Yergason’s Test, and possibly the Resisted Supination/External Rotation Test, as useful indicators of the presence of a SLAP lesion.
Making appropriate diagnostic judgements regarding SLAP lesions is particularly pertinent given the gold standard of management. Conservative management is ineffective for this lesion and therefore it is integral for the sports physiotherapist to successfully diagnose and refer appropriately.
- All of the clinical tests mentioned in this post can be watched in Video.
- For a clinically useful text for improving your diagnostic accuracy check out:
- This text is also available in our Online Store
This is a very brief review of the full article and is intended for information purposes only. The content discussed is opinion only. I strongly encourage you to read the article in its entirety for more complete information. This full article can be downloaded here.
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