title: Diagnostic accuracy of history and physical examination of superior labrum anterior- posterior lesions.
abstract: BACKGROUND
  Type I superior labrum anterior-posterior (SLAP) lesions involve degenerative fraying and probably are not the cause of shoulder pain. Type II to IV SLAP lesions are tears of the labrum.
  
  
  OBJECTIVE
  To determine the diagnostic accuracy of patient  history and the active compression, anterior slide, and crank tests for type I and type II to IV SLAP lesions.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Clinic.
  
  
  METHODS
  Fifty-five patients (47 men, 8 women; age = 40.6 ±  15.1 years) presenting with shoulder pain.
  
  
  METHODS
  For each patient, an orthopaedic surgeon conducted a clinical examination of history of trauma; sudden onset of symptoms; history of popping, clicking, or catching; age; and active compression, crank, and anterior  slide tests. The reference standard was the intraoperative diagnosis. The operating surgeon was blinded to the results of the clinical examination.
  
  
  METHODS
  Diagnostic utility was calculated using the receiver operating characteristic curve and area under  the curve (AUC), sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR). Forward stepwise binary regression was used to determine a combination of tests for diagnosis.
  
  
  RESULTS
  No history item or physical examination test had  diagnostic accuracy for type I SLAP lesions (n = 13). The anterior slide test had utility (AUC = 0.70, +LR = 2.25, -LR = 0.44) to confirm and exclude type II to IV SLAP lesions (n = 10). The combination of a history of popping, clicking, or catching and the anterior slide test demonstrated  diagnostic utility for confirming type II to IV SLAP lesions (+LR = 6.00).
  
  
  CONCLUSIONS
  The anterior slide test had limited diagnostic utility for confirming and excluding type II to IV SLAP lesions; diagnostic values indicated only small shifts in probability. However, the  combination of the anterior slide test with a history of popping, clicking, or catching had moderate diagnostic utility for confirming type II to IV SLAP lesions. No single item or combination of history items and physical examination tests had diagnostic utility for type I SLAP lesions.
authors.affiliation: Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA. lamichen@vcu.edu
authors.forename: Lori A
authors.initials: LA
authors.lastname: Michener
authors.forename: William C
authors.initials: WC
authors.lastname: Doukas
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Murphy
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Walsworth
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D051445:Fibrocartilage / Q000293:injuries* / Q000601:surgery; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology