The biceps load test 2 was specifically designed to gauge SLAP lesions. the primary biceps load test is meant to detect SLAP injuries in patients with chronic shoulder dislocation. The test is performed with the patient supine and therefore the examiner seated alongside holding the patient’s wrist and elbow. The patient is within the supine position with the jostle at 120 degrees of elevation and full external rotation, while the elbow is in 90 degrees of flexion, and therefore the forearm is in supination. The patient is then asked to flex the elbow because the clinician provides resistance.
Test
The patient is tested supine. The arm is abducted to 120°, externally rotated maximally, elbow in 90° flexion, and forearm supinated. If this test position reproduces pain then perform active elbow flexion against resistance.
Positive
The active elbow flexion component of the test should increase pain (or elicit pain) reproduced within the first a part of the test. The test is negative if the pain isn’t elicited on active elbow flexion, or if it’s unchanged or decreased.
The basis of the test is that the abduction/external rotation component changes the relative direction of the biceps tendon during a position obliquely angled to the posterosuperior labrum. The resultant contraction of the biceps increases the pain generated by increasing tension on the superior labrum that’s already peeled off the glenoid margin in abduction/external rotation.
Research
A prospective double-blind study of 127 patients.
Biceps Load 2 was positive in 38 patients – 35 had a type 2 SLAP
The test was negative in 89-
- 3 of these had a normal superior labrum
- 4 had a type 2 SLAP
- 85 had subacromial impingement or a rotator cuff tear
| Sensitivity | Specificity | PPV | NPV |
| 89.7% | 96.9% | 92.1% | 95.5% |
References
