Test library › Shoulder & upper arm
Modified dynamic labral shear (M-DLS) test
For: Shoulder labral injury
Website-only test: not part of the book.
A tear or other injury of the labrum, the rim of cartilage around the shoulder socket, at any point around the rim. This is wider than a SLAP lesion, which is a tear at the top of the labrum only.
Treat with caution (see below)LR+ as published by the study; the rounded 72% and 98% shown would give about 36. LR− calculated from the published sensitivity and specificity.
Caution: Single study by the test's developers; only the 101 of 325 patients who had surgery were checked against the reference.
These figures have not been confirmed against the full paper (checked against the abstract or a secondary source only).
How it is done
Patient standing. The examiner bends the elbow, raises the arm in the plane of the shoulder blade above 120° and turns it outward (external rotation) until tight, then applies horizontal abduction while lowering the arm from 120° to 60°. Positive: reproduction of the pain and/or a painful click or catch at the back of the joint line, typically between 120° and 90°.
What the studies found
Labral injury, as reported in the study, although the study set out to test superior (SLAP) lesions. Kibler et al. 2009 examined 325 consecutive patients with shoulder pain; only the 101 who went on to surgery could be checked against the surgical findings, which can flatter accuracy (partial verification). Developers' own study. Combined with O'Brien's test, it was the best combination for labral lesions. A 2012 review (Hegedus) noted that the dynamic labral shear may be sensitive for SLAP lesions but, when modified, diagnostic of labral tears generally. The original, unmodified dynamic labral shear (O'Driscoll's test) showed no useful accuracy for SLAP lesions in an independent study (Cook 2012).
What the numbers mean
- Positive result: see the caution above before relying on this result.
- Negative result: a small shift: a negative result nudges the diagnosis down, but does not exclude it.
The ladder: what a result does to your estimate
| If you thought | After a positive | After a negative |
|---|---|---|
| 10% | 78% | 3% |
| 30% | 93% | 11% |
| 50% | 97% | 22% |
Calculated from the likelihood ratios above. Read the caution above before relying on these. For any other starting estimate, use the probability calculator.
Work out what a result means for your patient: probability calculator
Source
Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37(9):1840–1847. Journal article (DOI) · single study
Also cited: Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. 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. PubMed
Also cited: Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg. 2012;21(1):13–22. Journal article (DOI)
Website-only test: added to the library on 9 October 2026 and not part of Rule It In, Rule It Out. Figures independently checked against the sources cited above; any note above says where only the abstract could be checked. If a newer or better study changes them, this page will be updated.
Get the book for the shoulder questions that matter: neck or shoulder, a painful cuff or a torn one, and an unstable joint or the labrum
This test is in the website library only; it is not one of the tests in Rule It In, Rule It Out. The book covers the tests in its ‘The shoulder’ chapter: how to do each one, what counts as positive, and how to read the result.
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