Speed’s Test

What is the Speed's Test?

A Speed's Test is an orthopedic physical exam designed to identify shoulder injuries such as superior labral tears (also called SLAP lesions) and biceps tendonitis. The test is considered sensitive to many shoulder pathologies, but non-specific, so subsequent tests are typically required for diagnostic accuracy.

A superior labral tear is an injury of the shoulder's glenoid labrum, which is part of the shoulder joint that serves as a stabilizer for the glenohumeral joint. It works to resist anterior and posterior movement and prevents the shoulder from dislocating when it reaches its farthest range of motion. The most common complaints of patients with a SLAP tear include hearing painful 'clicking' or 'popping' during shoulder movements and struggling to make overhead motions or lie on the affected shoulder.

Biceps tendonitis is a painful shoulder condition characterized by inflammation of the bicep's tendon. During the early stages of the condition, the biceps are inflamed and swollen. If left untreated, the tendon can thicken, increasing the risk of tearing. The Speeds test is one of the most effective preliminary techniques for detecting biceps pathology and other shoulder pathologies.

In this technique, the patient is asked to extend their elbow and fully supinate the forearm. The examiner places one hand on the foreman and exerts downward pressure while the patient applies manual resistance. The test is considered positive if the patient displays weakness or reports pain in the bicipital groove or tendon.

How to perform the Speed's Test

The Speed's Test is one of the simplest physical examination techniques for the assessment of shoulder lesions. It is non-invasive and doesn't require any equipment. It requires a collaborative effort from the healthcare professional and the patient. Here is how to perform the Speed's Test correctly:

1. Have your patient supinate their affected arm.
2. Have them slowly raise their arm to reach up to 90 degrees flexion.
3. As the patient slowly raises their arm, apply resistance in a downward direction using one hand on their forearm
4. Instruct your patient to apply resistance in an upward direction to counteract yours as they raise their arm. This ends once the arm reaches 90 degrees of flexion.
5. Repeat the test with the patient's arm pronated.

Alternatively, the Speed's Test can be conducted by setting the arm at either 60 or 90 degrees of flexion. The examiner applies downward pressure while the patient applies upward resistance, either to raise the arm from 60 to 90 degrees or to maintain it at 90 degrees. Like with the regular method, you must perform this while the arm is supinated and repeat it with the arm pronated.

How to interpret the findings of this test

An individual with no shoulder conditions should experience no pain or difficulty performing the Speed's Test. Observe if the patient's arm is weak and ask to them to report any pain while raising their arm and applying resistance.

• If the patient feels pain in the bicipital groove while the arm is supinated, the test is positive.
• If the patient's arm is weak, the test is also positive.
• If the patient does not feel pain and exhibits strength when you apply resistance to them while supinated and pronated, then the test is negative.
• If the patient complains of pain in the humerus region, this might be indicative of biceps tendonitis. If the arm is weak, that may be a sign that the long head of the biceps tendon is torn, but could also be indicative of a SLAP lesion.

After a positive Speed's Test, the next step is to refer the patient for further assessment to confirm the specific injury and check for other potential problems. From there, a healthcare provider can develop a treatment plan. Depending on the specific pathology of the lesion, treatment may include physical therapy, anti-inflammatory medication, arthroscopic surgery, or another related surgery.

When is it best to conduct the Speed's Test?

The Speed's Test is appropriate for patients experiencing pain in their upper extremities, or specifically shoulder pain. Symptoms such as reduced shoulder mobility, dull or sharp pain, 'clicking' of the joint when moving, and loss of strength (especially with overhead movement) are indicative of bicipital tendonitis or superior labral tearing and warrant a Speed's Test.

Most of the time, these injuries can heal with enough rest and rehabilitation. However, some cases of superior labral tears and biceps tendonitis require surgery, so it is crucial to refer patients for further examination following a positive Speed's Test.

The Speed's Test is not a diagnostic test because it cannot detect specific problems. It is therefore useful as part of a comprehensive physical examination because it can identify several possible diagnoses and determine what other tests should be conducted. Superior labral tears and biceps tendonitis often cause other problems such as shoulder instability and shoulder impingement.

What are the benefits of the Speed's Test?

Here are some of the benefits of performing this test:

Easy and cost-effective

One of the benefits of the Speed's Test is that it doesn't require any equipment from the examiner other than their hands. The instructions are straightforward, so this test can be accomplished quickly and accurately.

Streamlines diagnostic accuracy

The Speed's Test is often a great starting point in comprehensive evaluations as it will detect the possibility of superior labral tears and biceps tendonitis. The results are a useful directive for healthcare professionals in what further tests are necessary and what treatment is required.

Monitoring treatment progress

The Speed's Test can be repeated during routine check-ups to track treatment progress. This can help determine whether the injury is progressing and if adjustments to the treatment strategy are necessary.