Resisted Supination External Rotation Test

What are SLAP lesions of the shoulder?

SLAP lesions, or Superior Labrum Anterior to Posterior lesions, are injuries to the labrum, which is the ring of cartilage surrounding the shoulder socket. These lesions typically occur at the top (superior) part of the labrum, where the biceps tendon attaches to the shoulder. SLAP lesions are common among athletes, especially those involved in sports requiring repetitive overhead movements, such as baseball, tennis, and swimming.

Symptoms of SLAP lesions can vary but often include a deep, aching pain in the shoulder, particularly when performing overhead activities. Patients may experience a sensation of locking, popping, or grinding within the shoulder joint. Additionally, there can be a decrease in shoulder strength and a feeling of instability or weakness when lifting or throwing objects.

SLAP lesions can result from acute trauma or repetitive shoulder movements. Acute causes include falling onto an outstretched hand, a sudden pull on the arm, or a direct blow to the shoulder. Repetitive overhead activities, such as those performed by athletes, can also lead to these injuries. Over time, these movements can cause wear and tear on the labrum, leading to a SLAP lesion.

Knowing whether you have a SLAP lesion or not requires physical examination tests—one of them is the Resisted Supination External Rotation Test.

What is the Resisted Supination External Rotation Test?

The Resisted Supination External Rotation Test is a clinical examination procedure used to diagnose SLAP lesions in the shoulder. Developed as a specific test to evaluate the integrity of the superior labrum, the Resisted Supination External Rotation Test's anatomical basis is reproducing symptoms associated with SLAP lesions by mimicking the stress and movement patterns of the peel back mechanism, which typically cause pain and instability. Specifically, it stresses the superior labrum by increasing tension on the biceps brachii long head.

The test's development aimed to create a reliable and straightforward method for detecting SLAP lesions, which are often challenging to diagnose due to overlapping symptoms with other shoulder conditions. However, studies have shown that the Resisted Supination External Rotation Test has mixed reliability and validity. According to a systematic review by Somerville et al. (2017), the test's sensitivity stands at 14.3% and specificity at 80.8%, indicating a poor likelihood ratio; this suggests that while the test can diagnose superior labral anterior/posterior tears and SLAP lesions, it is less effective at ruling these out. As such, this research and other similar articles suggest that it is best to use it in conjunction with other clinical tests.

How is this test conducted?

This test is relatively straightforward. Follow these steps:

1. Position the patient in a supine position with the scapula of the affected side close to the edge of the table.
2. Support the patient's arm at the elbow and hand, placing the arm into 90 degrees of abduction with the elbow flexed to 65 to 70 degrees.
3. Ensure the forearm is in a neutral or slight pronation position.
4. Ask the patient to supinate their hand with maximal effort while you maximally externally rotate the shoulder.
5. Instruct the patient to describe any symptoms they experience during the test.

How are the results interpreted?

A negative result occurs when the patient does not experience any symptoms. A positive is indicated if the patient describes anterior or deep shoulder pain, clicking or catching in the shoulder, or reproduction of symptoms that occur during a throwing motion.

A positive result typically suggests a SLAP lesion, while posterior pain, apprehension, or no pain during the test does not indicate a positive result for a SLAP lesion. A positive test result warrants further diagnostic imaging or referral to a specialist for a comprehensive assessment and appropriate management.

How to use our Resisted Supination External Rotation Test template

Using our Resisted Supination External Rotation Test template can streamline the diagnostic process and ensure thorough documentation. Follow these steps:

Step 1: Access the template

Access the template by clicking "Use Template," which opens it in the Carepatron app. On the app, you can customize the template or share it with other teammates or users. You can also press "Download" to save a printable PDF straight to your device.

Step 2: Familiarize yourself with the test procedures

Review the template and understand the steps and criteria for the test.

Step 3: Do the test

Follow the procedures as outlined in the template. There is also an image in the template that will help you find the correct position for the test. Ensure you accurately record patient information, test findings, and any additional notes.

Step 4: Review and interpret results

Use the template to document whether the test is positive or negative and interpret the results accordingly.

How orthopedists address SLAP lesions

Orthopedists utilize various methods to address SLAP lesions, focusing on both non-surgical and surgical approaches to manage symptoms and restore shoulder function:

• Rest and activity modification: Reducing activities that exacerbate symptoms to allow healing and reduce inflammation.
• Physical therapy: Specific exercises to strengthen the shoulder muscles, improve flexibility, and restore range of motion.
• Medications: Anti-inflammatory drugs or corticosteroid injections to reduce pain and swelling.
• Arthroscopic surgery: Minimally invasive surgery to repair or remove the damaged part of the labrum. Procedures include labral repair, debridement, and biceps tenodesis.
• Open surgery: For complex cases or when arthroscopic surgery is not feasible, open surgery may be performed to repair the labrum and stabilize the shoulder.
• Post-surgical rehabilitation: A structured rehabilitation program to gradually restore shoulder function and strength after surgery.

These approaches are tailored to the patient's specific condition and activity level, aiming to achieve the best possible outcome for individuals with SLAP lesions.

Reference

Somerville, L., Willits, K., Johnson, A., Litchfield, R., LeBel, M.-E., Moro, J., & Bryant, D. (2017). Clinical assessment of physical examination maneuvers for superior labral anterior to posterior lesions. The Surgery Journal, 03(04), e154–e162. https://doi.org/10.1055/s-0037-1606829