V. Bélanger et al.
Appendix I. Description of orthopaedic special tests (OSTs)
OST LHBT injury Description of OST
Active compression
test (O’Brien) SLAP (Type 2) Patient with shoulder 90° forward flexed, 10–15° adducted and in full internal rotation (palm pronated), elbow
fully extended. Examiner applies a downward eccentric force to the arm. The manoeuvre is repeated in the
same position except with the shoulder in full external rotation (palm supinated).
Anterior slide test
(Kibler)
SLAP
Test considered positive if pain or clicking is produced inside the shoulder in the first part of the test and
eliminated or decreased in the second part.
Patient has hands on the waist, thumbs posterior. Examiner stabilizes the scapula and clavicle with one hand.
The other applies an anterosuperior force at the elbow.
Biceps load II (Kim II) SLAP Test considered positive if produces pain or click deep in the shoulder.
Patient sitting or in supine position, 120° shoulder abduction with lateral rotation, 90° elbow flexion, forearm
supinated. Examiner fully externally rotates shoulder. If apprehension appears, position is maintained and
patient is asked to flex elbow against resistance.
Crank test SLAP Test considered positive if apprehension increases or stays the same with elbow flexion.
Patient in supine position, arm elevated to 160° in scapular plane, elbow flexed. Examiner applies an axial
load to humerus with one hand while the other hand rotates the humerus medially and laterally.
Dynamic labral shear
test (O’Driscoll) SLAP Forced shoulder
abduction test SLAP Test considered positive if pain or click is induced between 90° and 120° abduction.
Patient seated. Examiner passively abducts the patient’s shoulder fully with elbow in full extension. Next,
keeping the same shoulder position, elbow is flexed.
Labral tension test SLAP Test considered positive if pain is greater with elbow extended than flexed.
Patient in supine position, 120° arm abduction, neutral forearm. Examiner holds the patient’s hand and resists
patient’s supination.
Mimori test SLAP Test considered positive if pain increases during supination.
Patient positioned with arm abducted 90–100°. Examiner laterally rotates the arm by holding the wrist, taking
the forearm in full supination and then full pronation.
Passive compression
test SLAP Test is considered positive if pain is more severe in pronated position or provoked only in that position.
Patient in side-lying position, the tested arm uppermost. Examiner stabilizes the shoulder over the scapula
and clavicle with 1 hand, while the other hand holds the arm in 30° abduction at the elbow. Passively, patient’s
shoulder is laterally rotated and arm pushed proximally and extended by the examiner’s hand on the elbow.
Test considered positive with pain on rotation.
Patient in supine or sitting position, arm at the side and unsupported, elbow flexed to 90°. Examiner fully
laterally rotates the arm with 90° abduction in the scapular plane. Next, examiner abducts the arm to 120°,
takes the arm into maximum horizontal abduction. Using his/her other hand, he/she applies an anterior shear
load to the joint.
Passive distraction test SLAP Test is considered positive if pain or click is felt in the glenohumeral joint.
Patient lies supine, arm abducted to 150°, elbow extended and forearm supinated. Examiner stabilizes the
humerus while pronating the forearm.
Gilchrest’s sign Tendinopathy Test is considered positive if pain is felt deep in the shoulder.
Patient standing with a 2–3 kg weight over the head, shoulder in full external rotation and arm straight.
Patient lowers the arm to the side in the coronal plane.
Groove palpation SLAP, rupture,
tendinopathy Test is considered positive when it elicits the usual patient discomfort or pain in the bicipital groove.
Patient positioned with 20–30° shoulder abduction, 90° elbow flexion and full forearm supination. Examiner
holds the forearm with 1 hand while palpating the shoulder with the other. Acromion is first palpated and then
the greater tuberosity of the humerus (38).
Heuter’s sign Rupture Test is considered positive if it creates or exacerbates the patient’s usual pain.
Patient positioned with neutral shoulder, 90° elbow flexion and forearm pronation. Examiner resists elbow
flexion.
Speed test Test is considered positive if no supination occurs.
SLAP (Type 2), rupture, Patient positioned with arm forward flexed 90°, first forearm supinated, then pronated. Examiner resists an
tendinopathy
eccentric movement sequentially in the 2 positions.
Upper cut test
Any lesion
Yergason’s manoeuvre Dislocation,
tendinopathy
Test is considered positive if it increases or creates the patient’s usual tenderness in the bicipital groove,
especially with the arm supinated.
Patient positioned with shoulder in neutral by the side, elbow flexed to 90°, forearm supinated and hand in a
fist. Examiner puts a hand over the fist to resist the patient while the patients tries to bring quickly the hand
up and toward the chin.
Test is considered positive if pain or a painful pop is elicited over the anterior shoulder.
Patient positioned with elbow flexed to 90° and stabilized against the thorax, forearm pronated. With 1 hand,
the examiner resists supination while the patient also laterally rotates the arm against resistance. The other
hand palpates the bicipital groove.
Test is considered positive if the tendon is felt to ”pop out” of the groove (dislocation) or induces patient’s
usual pain (tendinopathy).
SLAP: superior labrum anterior and posterior; LHBT: long head of the biceps tendon.
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