Execution
- 1Position the patient standing with the shoulder flexed to 90° and the elbow fully extended.
- 2Horizontally adduct the arm approximately 10° to 15° across midline.
- 3Internally rotate the shoulder so the thumb points downward and applies a downward eccentric force.
- 4Repeat the same manoeuvre with the forearm fully supinated and the palm facing upward.
- 5Compare pain location and symptom reduction between the two positions.
Positive outcome
For SLAP / labral interpretation, deep shoulder joint pain or painful clicking in the thumb-down position that decreases or disappears in the palm-up position is positive. Pain directly over the acromioclavicular joint should be interpreted as AC-joint pain rather than SLAP pain.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| O’Brien et al. (1998) | NA | 100 | 98.5 | 66.66 | NA |
| Stetson & Templin (2002) | NA | 54 | 31 | 0.78 | 1.48 |
CommentThe original O’Brien study reported striking values, but later studies found much weaker accuracy for labral pathology. The test also loads the AC joint, so pain location is essential. In modern use it is best treated as one piece of a SLAP / biceps-labrum cluster rather than a standalone rule-in test.
Moderate Clinical Value