Biceps Load Test

Biceps Load Test is composed of two parts, Biceps Load Test I and Biceps Load Test II. Both of them used to evaluate the SLAP lesion but the former used in SLAP lesion with anterior shoulder instability, while the latter is used for isolated SLAP lesion without anterior shoulder instability.

Biceps Load Test I

Biceps Load Test I is used to diagnosis of superior labral tears in patients who have anterior shoulder instability associated with Bankart lesions.

See Also: What is SLAP Lesion?

How do you Perform the Biceps Load Test I?

• The patient is placed supine with the arm abducted to 90 degrees.
• The elbow is flexed 90° and the arm is placed in a neutral rotation.
• The forearm is supinated and then an anterior apprehension maneuver is performed (external rotation of the arm ).
• If a feeling of instability or anterior shoulder pain occurs, external rotation is stopped.
• The patient is then asked to actively flex the forearm at the elbow against resistance by bringing the hand toward the face.
• During this maneuver, the patient is asked whether the feeling of instability is improved, unchanged, or worsened

What does a positive Biceps Load Test I mean?

• If the pain and feeling of instability improve, there is no indication of a SLAP lesion.
• If the symptoms are unimproved or even worsened, then there is suspicion of a SLAP lesion.
• The examiner should note that the forearm should be supinated during the test. Also, the examiner should be at the same level as the patient.

Biceps Load Test I Accuracy

A study on 75 patients with unilateral recurrent anterior shoulder dislocations (SLAP lesion diagnosed by arthroscopy ), the biceps load test revealed a sensitivity and a specificity as following:

• Sensitivity: 90 %
• Specificity: 97 %

Biceps Load Test II

Biceps Load Test II is used for isolated SLAP lesions independent of shoulder instability.

The patient is supine with the arm abducted to 120°. The arm is externally rotated to its maximal extent, the elbow flexed at 90° and the forearm supinated. The patient is then asked to flex the elbow further, trying to bring the hand to the head against the resistance of the examiner’s hand. Wilk et al. also advocate doing the test with the forearm pronated (pronated biceps load test).

There is suspicion of a SLAP lesion if the test triggers pain deep in the joint or along the joint line.

The biceps load test II is an effective diagnostic test for SLAP lesions. It has a sensitivity of 89.7% and a specificity of 96.9%.

A study on 68 patients with type II SLAP lesions and 78 age matched controls who underwent shoulder arthroscopy (Type II SLAP lesion visualized during arthroscopy ), the sensitivity and specificity of biceps load test II was 30% and 78%, respectively.

See Also: Obriens test

Habermeyer Supine Flexion Resistance Test

Habermeyer Supine Flexion Resistance Test is used to evaluate pathology in the area of the upper labrum biceps tendon complex.

The patient lies supine and elevates the arms maximally over the head so they rest on the examination table with the palms upward. The examiner stands alongside the patient on the side of the shoulder to be examined and holds the patient’s arm just below the elbow. The patient is asked to raise the arm up from this position against the resistance of the examiner’s hand.

One must assume that a SLAP lesion is present if the patient reports pain deep in the shoulder joint or along the posterior joint line from the strain from the flexion (throwing movement) against resistance.

References

1. Kim SH, Ha KI, Ahn JH, Kim SH, Choi HJ. Biceps load test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy. 2001 Feb;17(2):160-4. doi: 10.1053/jars.2001.20665. PMID: 11172245. Pubmed
2. Kim SH, Ha KI, Han KY. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. Am J Sports Med. 1999 May-Jun;27(3):300-3. doi: 10.1177/03635465990270030501. PMID: 10352763. Pubmed
3. Oh JH, Kim JY, Kim WS, et al. The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion. Am J Sports Med. 2008;36:353-359.
4. Wilk KE, Reinold MM, Dugas JR, et al. Current concepts in the recognition and treatment of superiorlabral (SLAP) lesions. J Orthop Sports Phys Ther.2005;35:273–291.
5. Clinical Tests for the Musculoskeletal System 3rd Edition.
6. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.