Resisted Supination External Rotation Test (RSERT)

The Resisted Supination External Rotation Test (RSERT) stands as a crucial diagnostic tool in orthopedic examination, specifically designed to evaluate Superior Labrum Anterior and Posterior (SLAP) lesions. This examination technique has gained significant recognition for its ability to recreate the peel-back mechanism associated with superior labrum pathology.

The RSERT’s primary purpose centers on identifying SLAP lesions through a mechanism that mimics the natural biomechanical stress placed on the superior labrum. Understanding this test’s methodology and interpretation proves essential for healthcare providers specializing in shoulder pathologies.

See Also: Shoulder SLAP Lesion

How to perform the Resisted Supination External Rotation Test (RSERT)?

The execution of Resisted Supination External Rotation Test requires precise positioning and careful attention to technique. The patient assumes a supine position with their scapula positioned near the examination table’s edge. The examining clinician stands adjacent to the patient, establishing control of both the elbow and hand of the affected arm.

The positioning sequence involves several critical elements: The shoulder requires 90 degrees of abduction The elbow should maintain 65-70 degrees of flexion. The forearm begins in neutral rotation or slight pronation.

During the examination, the practitioner instructs the patient to perform maximal supination against resistance. While maintaining this resistance, the examiner then guides the shoulder through lateral rotation to its terminal range.

See Also: Crank Test | Shoulder SLAP Lesions

What does a positive RSERT mean?

A positive Resisted Supination External Rotation Test manifests through several key indicators: Anterior shoulder pain or deep shoulder discomfort Clicking or catching sensations within the shoulder joint Recreation of the patient’s symptomatic complaints

Conversely, the test registers as negative when: Pain localizes to the posterior shoulder No pain occurs during the examination The patient experiences apprehension without pain.

Reliability & Validity

In one Cohort study, the resisted supination external rotation test had the highest sensitivity (82.8%), specificity (81.8%), positive predictive value (92.3%), negative predictive value (64.3%), and diagnostic accuracy (82.5%) of all tests performed.

By re-creating the peel-back mechanism, the resisted supination external rotation test is more accurate than 2 others commonly used physical examination tests designed to diagnose superior labral anterior posterior tears in overhead-throwing athletes. By using this test in the context of a thorough clinical history and physical examination, lesions of the superior labrum can be more reliably diagnosed.

Medical professionals should consider the Resisted Supination External Rotation Test as part of a complete shoulder examination protocol. Research indicates its utility in identifying SLAP lesions, though correlation with additional clinical findings and imaging studies remains essential for definitive diagnosis.

References & More

1. Dessaur WA, Magarey ME. Diagnostic accuracy of clinical tests for superior labral anterior posterior lesions: a systematic review. J Orthop Sports Phys Ther. 2008 Jun;38(6):341-52. doi: 10.2519/jospt.2008.38.6.341. Epub 2008 Feb 22. PMID: 18515961. Pubmed
2. Myers TH, Zemanovic JR, Andrews JR. The resisted supination external rotation test: a new test for the diagnosis of superior labral anterior posterior lesions. Am J Sports Med. 2005 Sep;33(9):1315-20. doi: 10.1177/0363546504273050. Epub 2005 Jul 7. PMID: 16002494. Pubmed
3. Orthopedic Physical Assessment by David J. Magee, 7th Edition.