shoulder labrum tear test

3 min read 18-03-2025

A shoulder labrum tear is a common injury affecting the ring of cartilage (labrum) that surrounds the shoulder socket. Accurate diagnosis is crucial for effective treatment. Several physical tests, performed by a doctor or physical therapist, help determine if you have a shoulder labrum tear. This article explores common tests used to diagnose a shoulder labrum tear.

Understanding the Shoulder Labrum

Before diving into the tests, let's understand the shoulder labrum's function. The labrum acts like a gasket, deepening the shoulder socket and providing stability. Tears can occur from trauma (like a fall or direct impact) or from repetitive overhead movements.

Common Shoulder Labrum Tear Tests

Several physical examination maneuvers help diagnose a labrum tear. These tests don't provide a definitive diagnosis but help guide further investigation. Your doctor might use a combination of these tests.

1. The Apprehension Test

This test checks for anterior (front) labral tears. Your doctor will passively abduct and externally rotate your arm. A positive test occurs if you show signs of apprehension or pain as your arm nears the end range of motion. This signifies potential instability and a possible anterior labral tear (ALTA).

2. The Relocation Test

Often performed after the apprehension test, this assesses the same area. Your doctor applies downward pressure on your humeral head (the ball of your shoulder joint). If pain and apprehension subside with this pressure, it suggests the labrum is unstable and may be torn.

3. The Jerk Test (Anterior Labral Tear)

The jerk test aims to reproduce the "jerk" or "click" sometimes felt with an anterior labral tear. Your arm will be passively abducted and externally rotated, then the doctor quickly flexes your shoulder to the end range of motion. A positive test is indicated by a palpable or audible click.

4. The O'Brien Test

The O'Brien test assesses for superior labral anterior posterior (SLAP) tears, which affect the upper part of the labrum. Your arm is positioned in specific positions (flexion and internal or external rotation), then resisted movements are performed. Pain with internal rotation and less pain with external rotation are consistent with a SLAP lesion.

5. The Active Compression Test (Active Compression O'Brien's Test)

Similar to the O'Brien test, but with the arm held in a different starting position. The patient actively moves their arm, resisting pressure from the examiner. This helps isolate the SLAP lesion.

6. The Load and Shift Test

This test assesses the stability of the glenohumeral joint. The doctor manipulates your humeral head to feel for laxity or instability, indicating potential labral damage.

7. The Crank Test

With your arm at your side, the doctor will flex and externally rotate your arm, feeling for any unusual clicking or pain in the shoulder.

8. Speeds Test

With your elbow extended and your forearm supinated (palm up), the doctor will passively abduct and externally rotate your arm. A positive test is noted when there is pain indicating possible biceps tendon pathology, which is often associated with SLAP tears.

9. Yergason's Test

This tests for bicep tendon pathology which can sometimes accompany SLAP tears. The patient flexes their elbow to 90 degrees and supinates their forearm against resistance. Pain indicates a potential biceps pathology issue.

Imaging and Diagnosis

While these physical tests are valuable, they don't definitively diagnose a labrum tear. Imaging techniques like MRI arthrography or ultrasound are often necessary to confirm the diagnosis and assess the tear's severity. These tests offer a clearer picture of the labrum and surrounding structures.

What to Expect After the Tests

Following the physical exam, your doctor will discuss the findings and recommend the next steps. This might involve:

Conservative Treatment: For mild tears, non-surgical treatments like physical therapy, rest, and anti-inflammatory medication are often recommended.
Surgical Repair: More significant tears might require arthroscopic surgery to repair the labrum.

It’s crucial to remember that these tests are part of a diagnostic process. Your doctor will consider your medical history, symptoms, and the results of the physical exam and imaging to create a comprehensive treatment plan. Always consult with a medical professional for any shoulder pain or suspected injury. Self-diagnosis can be dangerous and delay appropriate treatment.