The validity and accuracy of clinical tests used to detect labral pathology of the shoulder—a systematic review

Wendy Munro, Raymond Healy
Manual Therapy 2009, 14 (2): 119-30
Labral tears frequently require repair [Kim S, Ha K, Han K. Biceps Load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. The American Journal of Sports Medicine 1999;27(3):300-3]. Physiotherapists need confidence in clinical tests used to detect labral pathology to accurately identify this condition. This review systematically evaluates the evidence for the accuracy of these tests with reference to study quality and key biases. Cochrane, Medline, Cinahl, AMED, DARE and HTA databases were searched to identify 15 studies evaluating 15 clinical tests for labral pathology against Magnetic Resonance Imaging MRI or surgery. Two independent reviewers assessed methodological quality using Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Meta Disc calculated likelihood ratios (positive LR>10, providing convincing diagnostic evidence of ruling a condition in; negative LR<0.2 providing large to moderate evidence of ruling the condition out) and true positive rates (TPRs) against false positive rates (FPRs) in receiver operator characteristic (ROC) plots and summary receiver operator curves (SROCs). Probable overestimation of accuracy was caused by use of case control design, verification bias and use of a lesser reference standard. Six accurate tests; Biceps Load I (+LR: 29.09; -LR: 0.09) Biceps Load II (+LR: 26.32; -LR: 0.11), Internal Rotation Resistance (IRRT) (+LR: 24.77; -LR: 0.12), Crank (+LR: 13.59 and 6.46; -LR: 0.1 and 0.22), Kim (+LR: 12.62; -LR:0.21) and Jerk (+LR: 34.71; -LR: 0.27) tests were identified from high quality single studies in selected populations. Subgroup analysis identified varying results of accuracy in the Crank test and the Active Compression (AC) test when evaluated in more than one study. Further evaluation is needed before these tests can be used with confidence.

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