title: Clinical Assessment of the Dynamic Labral Shear Test for Superior Labrum Anterior and Posterior Lesions.
abstract: BACKGROUND
  Diagnosing superior labrum anterior and posterior (SLAP) lesions through physical examination remains challenging. The dynamic labral shear test (DLST) has been shown to have likelihood ratios (LRs) of 31.6 and 1.1 for diagnosing SLAP lesions.
  
  
  OBJECTIVE
  To determine the clinical utility of the DLST for diagnosing SLAP lesions.
  
  
  METHODS
  Cohort study (diagnosis); Level of evidence, 2.
  
  
  METHODS
  This prospective, consecutive case series included 774 patients who underwent diagnostic arthroscopy and a preoperative DLST between 2007 and 2013. Patients were divided into 3 groups: 610 control patients with no SLAP lesion but with other abnormalities, 9 patients with isolated SLAP lesion (ISL), and 155 patients with concomitant SLAP lesion (CSL), who had a SLAP lesion and another shoulder abnormality. We determined sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), and diagnostic accuracy (DA) of the DLST with and without other tests.
  
  
  RESULTS
  The DLST was positive for 242 of 610 controls (40%), 7 of 9 patients (78%) in the ISL group, and 88 of 155 patients (57%) in the CSL group. In the ISL group, the DLST had a sensitivity of 78%, specificity of 51%, PPV of 2%, NPV of 100%, OR of 3.58, and DA of 51%. In comparison, the ORs were 1.09 for the active compression test, 1.30 for the lift-off test, and 1.53 for the relocation test, which were not significantly different from each other. For diagnosing a SLAP lesion existing in a joint with other associated injury, the DLST had a sensitivity of 57%, specificity of 52%, PPV of 23%, NPV of 83%, OR of 1.4, and DA of 53%. Combining all 4 tests did not improve the OR for detecting ISLs or CSLs.
  
  
  CONCLUSIONS
  The DLST is sensitive but not specific for detecting ISLs. With an OR of 3.58, the DLST is useful for diagnosing ISLs. However, in patients who have CSLs, the DLST is not as useful for diagnosing SLAP lesions.
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Sonal
authors.initials: S
authors.lastname: Sodha
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Srikumaran
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Kyubo
authors.initials: K
authors.lastname: Choi
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Amrut U
authors.initials: AU
authors.lastname: Borade
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Edward G
authors.initials: EG
authors.lastname: McFarland
mesh_terms: D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D012782:Shoulder / Q000002:abnormalities; D000070599:Shoulder Injuries / Q000175:diagnosis* / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology*; D055815:Young Adult
keywords: SLAP lesion; diagnostic accuracy; physical examination; shoulder