Pain Provocation Test for Superior Labral Tear

Abstract

We assumed that pain provoked by an anterior apprehension that varies with theposition of the forearm, and this difference can be useful when diagnosing a superior labral lesion. We investigated the value of this pain provocation test in throwing injuries of the shoulder.
The subjects consisted of 32 patients who were diagnosed w ith throwing injuries of the shoulder. There were 30 males and 2 females (mean age,20.9 years). patients with a rotator cuff tear in the MRI or arthrography or with a dislocation of the glenohumeral joint were excluded from this study. We studied the severity of pain provoked by an anterior apprehension test in two different positions of the forearm: pronation and supination, and compared the findings of the MR arthrography with the results of the pain provocation test.
In 22 cases, detached superior labrums were observed in the MR arthrogram. All these cases complained of more severe pain when their forearms were pronated. On the other hand, a detached anterior labrum only in the MR arthrogram was observed in one case. In this case, the pain did not change regardless of the forearm position. The other 9 cases had no labral tears in their MR arthrograms, and only one case out of the 9, complained of increased pain in the pronated position.
We defined this pain provocation test as positive when pain occurred only in pronation or the pain in pronation was more severe then that in supination. The values of this pain provocation test were as follows: sensitivity 100%, specificity 89% and accuracy 95%. This test seems to be most useful in predicting a superior labral tear.