Yergason Test

Context

The Yergason Test is often used to assist in the diagnosis of SLAP lesions and biceps conditions.

The glenoid labrum is a fibrocartilaginous structure that plays an important role in the stability of the glenohumeral joint. One form of injury to this structure is the superior labrum anterior-to-posterior tear, or SLAP lesion.

First described in 1985, they are classified into 10 different types, the most common being type 2, in which the labrum detaches from the superior aspect of the glenoid.

SLAP lesions can result from acute trauma or chronic overuse, frequently observed in throwing athletes. They can also occur with age-related natural degeneration of the labrum. Although the true incidence of SLAP lesions is unknown, their presence during shoulder surgical procedures ranges from 3.3% to 26%.

Several physical examination maneuvers are used to diagnose a SLAP lesion, among which is the Yergason Test.

Video of the Test

Execution

To perform the test, the patient flexes the forearm to 90° in full pronation. The patient is then asked to perform supination, which the physical therapist resists. At the same time, the physical therapist palpates the biceps tendon in the groove.

If the biceps tendon is felt to snap out of the groove, this indicates a tear of the transverse humeral ligament. Simple tenderness or pain of the tendon may indicate biceps tendinopathy or a SLAP lesion.

Clinical Value

In 2023, a systematic review conducted by Dean and colleagues aimed to compare the performance of physical examination maneuvers in the diagnosis of SLAP lesions and to conduct a meta-analysis comparing the sensitivity and specificity of these tests individually and in combination (Dean et al., 2023).

The tests evaluated were the O’Brien Test, the Yergason Test, the Jobe Test, the Crank Test, the Speed Test, the Anterior Slide Test, palpation, the Kim Test, and the Dynamic Labral Shear Test.

Individually and across an average of 6 studies (N = 543), the Yergason Test had a sensitivity of 18.4 (11.3–28.6) and a specificity of 87.8 (77.3–93.8). It therefore had the highest specificity of the test group but the lowest sensitivity. The authors indicate that the ability of the Yergason Test to detect both biceps conditions and SLAP lesions may explain the large difference between its reported specificity and sensitivity.

However, this systematic review demonstrates improved specificities when tests are used in series and improved sensitivities when used in parallel combinations.

To better understand the difference between a series and a parallel test combination:

In a series strategy, the primary objective is to reduce false positives. Tests are combined such that only subjects with positive results on all tests are ultimately considered positive. In practice, this means applying a second test only to subjects who obtained a positive result on the first test, which increases overall specificity.

Conversely, a parallel strategy aims to minimize false negatives. Here, tests are combined such that a subject is declared positive if they obtain a positive result on at least one of the tests. In practice, this involves applying a second test only to subjects who obtained a negative result on the first test, which improves overall sensitivity.