Shoulder Speed Test

Speed Test (also called Palm-Up Test or Straight Arm Test) is used to evaluate Biceps tendinitis and Superior labral anterior and posterior lesions (Slap Lesion).

It was first described by Crenshaw and Kilgore in 1966.

See Also: SLAP Lesion

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How do you do the Shoulder Speed Test?

• With the patient in sitting or standing position. The elbow is extended and the GH joint is in neutral position or slightly extended to stretch the biceps brachii.
• The examiner stands lateral to and in front of the involved limb, the fingers of one hand are positioned over the bicipital groove while stabilizing the shoulder. The forearm is stabilized proximal to the wrist.
• The clinician resists flexion of the GH joint while palpating for tenderness over the bicipital groove. Allow the patient to move through flexion ROM.

The active Speed’s test where the examiner resists elbow flexion and forward flexion simultaneously may also
be helpful in the detection of SLAP lesions.

What does a positive Speed Test mean?

• A side-to-side difference in the strength of elevation of the shoulder with pain in the bicipital groove region suggests pathology in the long head of the biceps such as tenosynovitis or subluxation.
• If profound weakness is found on resisted supination, a second or third degree sprain of the biceps tendon should be suspected.

Positive speed test may indicate:

1. Inflammation of the long head of biceps tendon as it passes through the bicipital groove.
2. Possible tear of the transverse humeral ligament with concurrent instability of the long head of biceps tendon as it passes through the bicipital groove .
3. SLAP lesion (with pain at the superior shoulder).

Sensitivity & Specificity

In an arthroscopic analysis that included biceps tendinitis and superior labral anterior and posterior lesions (SLAP Lesion) as positive findings, Bennett found that the Speed test had a sensitivity and Specificity as following ¹:

• Sensitivity: 90 %
• Specificity:  14 %

With the high sensitivity, a negative finding effectively rules out biceps tendon pathology. The small positive likelihood ratio indicates that the speed test adds little diagnostic value in confirming the presence of biceps tendon pathology.

In a number of studies, the sensitivity of the Speed’s test in biceps tendon disorders was found to be higher than that of the Yergason’s test.

Because Speed’s test has been shown to be highly sensitive but not specific to biceps pathology, it should be used as an aid in the evaluation of a bicipital lesion but not as diagnostic of such a lesion.

Population	Reference Standard	Sens	Spec	+LR	−LR
Pooled estimates from four studies (n = 327)	SLAP lesion diagnosed by arthroscopy	.20 (.05, .53)	.78 (.58, .90)	.90 (.43, 1.9)	1.0 (.86, 1.2)
Pooled estimates from four high-quality studies	SLAP lesion visualized during arthroscopy	.32 (.24, .42)	.61 (.54, .68)	.80	1.11
68 patients with type II SLAP lesions and 78 age-matched controls who underwent shoulder arthroscopy	SLAP lesion visualized during arthroscopy	.32	0.66	.90	1.03
847 patients who underwent diagnostic arthroscopy of the shoulder	Partial biceps tendon tear visualized during arthroscopy	.50	.67	1.5	.75

Reference

1. W F Bennett: Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy. Nov-Dec 1998;14(8):789-96. doi: 10.1016/s0749-8063(98)70012-x. PMID: 9848587.
2. Holtby R, Razmjou H. Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20:231-236.
3. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978.
4. Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42:80-92, discussion 92.
5. Ebinger N, Magosch P, Lichtenberg S, Habermeyer P. A new SLAP test: the supine flexion resistance test. Arthroscopy. 2008;24:500-505.
6. 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.
7. Gill HS, El Rassi G, Bahk MS, et al. Physical examination for partial tears of the biceps tendon. Am J Sports Med. 2007;35:1334-1340.
8. Wilk, KE, et al: Current concepts in the recognition and treatment of superior labral (SLAP) lesions. J Orthop Sports Phys Ther, 35:273, 2005.
9. Bennett, WF: Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy, 14:789, 1998.
10. Campbel’s Operative Orthopaedics 13th Ed Book.
11. Clinical Tests for the Musculoskeletal System, Third Edition book.
12. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
13. Millers Review of Orthopaedics, 7th Edition Book.