Shoulder Anterior Slide Test

Shoulder Anterior Slide Test is a provocative test used to evaluate the SLAP lesion of the shoulder. It was first described by Kibler in 1995.

It utilizes the rationale that a combined compression and shear force applied to the torn superior labrum will produce pain and/or mechanical symptoms such as clicking.

How do you perform the Anterior Slide Test?

To perform this test, the patient is asked to place each hand on the iliac crests with the thumb pointed posteriorly. The examiner stabilizes the scapula by placing one hand on the top of the affected shoulder and the other hand across the epicondyles of the affected arm. The examiner then applies an anterosuperior axial load through the humerus directed towards the anterosuperior aspect of the glenoid.

McFarland et al. have described the test as the examiner applying an axial upward load to the glenohumeral joint that the patient resists.

What does a positive Anterior Slide Test mean?

Reproduction of the patient’s symptoms is regarded as a positive test indicating the presence of SLAP lesion.

See Also: Shoulder SLAP Lesion

Test Accuracy

In Kibler’s original study of five groups of athletes, the sensitivity and specificity of the anterior slide test was calculated to be:

• Sensitivity: 78.4%
• Specificity: 91.5 %

However, this study did not involve a diagnostic gold standard.

Burkhart et al. calculated a sensitivity of 100 % and a specificity of 47 % for the diagnosis of type II SLAP tears using the anterior slide test. The investigators also found that the anterior slide test was more accurate in the detection of anterior lesions when compared to posterior or combined anterior–posterior SLAP lesions.

A more recent study by Schlecter et al. evaluated 254 patients using the anterior slide test and correlated the results with arthroscopic findings. The investigators calculated a sensitivity of 21 % and a specificity of 98 % for the detection of type II–IV SLAP tears using the anterior slide test. When the anterior slide test was performed in combination with the so-called passive distraction test described by Rubin (passive forearm pronation with the humerus in 150° of abduction in the scapular plane), the sensitivity was 70 % and the specificity was 90 % for the detection of type II–IV SLAP tears.

The utility of the anterior slide test to detect type I SLAP lesions is less reliable; however, the clinical relevance of the type I SLAP lesion has been questioned.

References

1. Kibler WB. Specificity and sensitivity of the anterior slide test in throwing athletes with superior glenoid labral tears. Arthroscopy. 1995 Jun;11(3):296-300. doi: 10.1016/0749-8063(95)90006-3. PMID: 7632305.
2. Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14(6):637–40.
3. McFarland EG, Tanaka MJ, Papp DF. Examination ofthe shoulder in the overhead and throwing athlete.Clin Sports Med. 2008;27:553–578.
4. Schlecter JA, Summa S, Rubin BD. The passive distraction test: a new diagnostic aid for clinically significant superior labral pathology. Arthroscopy. 2009;25(12):1374–9
5. McFarland EG, Kim TK, Savino RM. Clinical assessment of three common tests for superior labral anterior-posterior lesions. Am J Sports Med. 2002;30(6):810–5.
6. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14(6):553–65.
7. Sakurai G, Ozaki J, Tomita Y, Nishimoto K, Tamai S. Electromyographic analysis of shoulder joint function of the biceps brachii muscle during isometric contraction. Clin Orthop Relat Res 1998;(354): 123–131.
8. Millers Review of Orthopaedics -7th Edition Book.