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Test library › Shoulder & upper arm

Passive distraction test

For: SLAP lesion

Website-only test: not part of the book.

A tear of the top of the labrum, the rim of cartilage around the shoulder socket, where the long head of biceps attaches. SLAP stands for superior labrum, anterior to posterior.

Treat with caution (see below)
Sensitivity53%
Specificity94%
LR+ (positive)8.83
LR− (negative)0.5

Likelihood ratios calculated from the published sensitivity and specificity.

Caution: Retrospective single study by the test's developers; shoulders that could not reach the test position were excluded.

These figures have not been confirmed against the full paper (checked against the abstract or a secondary source only).

How it is done

Patient supine, shoulder at the edge of the couch. The arm is raised to about 150° in the plane of the shoulder blade, elbow straight and palm turned up (forearm supinated). Keeping the shoulder in that position, the examiner turns the forearm palm-down (pronation). Positive: deep pain in the shoulder, at the front or the back.

What the studies found

SLAP lesion. Schlechter et al. 2009 reviewed 254 consecutive shoulder arthroscopies; 61 (24%) had a clinically significant SLAP lesion. Sensitivity 53%, specificity 94%. A retrospective study by the test's developers. Patients who could not raise the arm to 150°, or had pain in the starting position, were excluded, so the figures apply only to shoulders that can reach the test position. A 2012 review (Hegedus) singled it out as a highly specific test from a low-bias study that may rule a SLAP lesion in when positive. A negative test does not rule a SLAP lesion out.

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 thoughtAfter a positiveAfter a negative
10%50%5%
30%79%18%
50%90%33%

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

Other tests in the library for SLAP lesion

Compare all the tests for SLAP lesion side by side

Source

Schlechter JA, Summa S, Rubin BD. The passive distraction test: a new diagnostic aid for clinically significant superior labral pathology. Arthroscopy. 2009;25(12):1374–1379. 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

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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