As surgical procedures have advanced, so has our ability to diagnose and treat such injuries, as we have become more aware of the labral structure and the nature of SLAP injuries. The superior labrum has been found to have a loose attachment to T he surgical management of superior labral anterior posterior (SLAP) lesions of the shoulder has advanced in recent years, as arthroscopic techniques have led to a better understanding of labral anatomy and pathomechanics. With the complicated injuries that may occur at this site, greater emphasis is placed on accurate diagnosis and treatment to return patients to full function.STUDY DESIGN: Systematic literature review. OBJECTIVES:To conduct a systematic review of case series and clinical trials that investigate the diagnostic accuracy of clinical tests for superior labral anterior posterior (SLAP) lesions. BACKGROUND: Primary contact practitionersare often presented with shoulder problems and use a battery of clinical tests to reach a diagnosis. Early detection of SLAP pathology may lead to more optimal interventions and better outcomes for patients. METHODS AND MEASURES:The OVID search interface was utilized with MEDLINE, AHMED, CI-NAHL, and SPORTDiscus databases searched from 1996 to 2006. Studies were retrieved that included patients with shoulder pain who underwent at least 1 clinical shoulder test for SLAP lesions. For an article to be included in this review, the results of the clinical tests needed to be compared with findings on arthroscopy. Quality of the manuscripts included in this review were rated using the QUA-DAS appraisal tool, so comparisons could be made across studies. RESULTS:Seventeen published manuscripts fit the inclusion/exclusion criteria and were used for this review. Eight studies were found to be of high quality. Within these 8 studies, 1 group of authors reported high diagnostic accuracy values for the crank test: sensitivity, 91% (95% confidence interval [CI], 76%-97%); specificity, 93% (95% CI, 79%-98%); positive likelihood ratio, 13.6 (95% CI, 3.6-52.1); and negative likelihood ratio, 0.1 (95% CI, 0.0-0.3). One study on the resisted supination external rotation test also scored high on the QUADAS and reported diagnostic accuracy values of 83% (95% CI, 66-92), 82% (95% CI, 52-95), 4.6 (95% CI, 1.3-16.1), and 0.20 (95% CI, 0.1-0.5), respectively. Of significance is the fact that the majority of papers reporting highly accurate clinical diagnostic tests were of low quality, with the results not supported by other authors.CONCLUSION: It appears that no single test is sensitive or specific enough to determine the presence of a SLAP lesion accurately. Further research is required to determine whether subgrouping of patients by mechanism of injury or the type of SLAP lesion may improve diagnostic accuracy. Determining the diagnostic accuracy of a combination of 2 or more tests is also needed. Ther 2008;38(6):341-352. doi:10.2519/jospt.2008 The vascularity of the labrum is less in the superior and anterosuperior regions compared to the inferior...
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