Supine Flexion Resistance Test

Context

Subacromial impingement is a frequent cause of shoulder pain. The mechanisms of impingement are complex, and a number of secondary conditions may be associated with it. These include subacromial / subdeltoid bursitis, tendinopathy or tear of the rotator cuff or of the long head of the biceps tendon, and glenoid labrum lesions (Hanchard et al., 2013).

Today, a debate exists on terminology, and we avoid using the word “impingement.” This term can have negative connotations and worry patients, who then fear further damage to their shoulder. We prefer the term “rotator cuff-related shoulder pain.” This better reflects the complexity of the situation and the fact that we do not yet understand all the mechanisms involved (Littlewood et al., 2019).

Superior labral tears involving the biceps anchor are common, particularly in athletes, and can significantly impair shoulder function (Brockmeyer et al., 2016). However, SLAP lesions (“superior labrum anterior to posterior”) are particularly difficult to diagnose for several reasons. They are often associated with other shoulder conditions, existing tests generally have low diagnostic accuracy, and they lack a specific pain pattern (Familiari et al., 2019).

Among the tests that can be used to detect SLAP lesions is the Supine Flexion Resistance Test (Ebinger et al., 2008).

Video of the Test

Execution

To perform this test, the patient lies supine, with the arm to be examined placed above the head in full extension, palm facing upward. The physical therapist stands on the side of the shoulder being tested and grasps the patient’s arm just below the elbow. The patient is then asked to perform a throwing movement against the physical therapist’s resistance. The test is considered positive if this movement produces deep pain in the shoulder joint or along its posterior aspect, along the joint line. When the test is performed on the asymptomatic shoulder, no pain should be felt.

Clinical Value

The Supine Flexion Resistance Test has been reported to have a sensitivity of 80% and a specificity of 69% for detecting SLAP lesions (Ebinger et al., 2008). However, it should be noted that this is the only study we found concerning its clinimetric properties.