Which test is used to identify superior labral tears or proximal biceps impairment?

• A. Roos
• B. Clunk
• C. Speed
• D. O'Brien

Answer: (D)

The test that targets the structures at the top of the shoulder—the superior labrum and the proximal biceps tendon—is designed to provoke pathology there. To perform it, position the arm with about 90 degrees of forward flexion and a slight across-the-body adduction, with the forearm pronated (thumb pointing down). The examiner provides a downward push and the patient resists. Then repeat with the forearm in supination (palm up). A positive finding is pain reproduced in the initial, pronated position that is relieved when the forearm is supinated. This pattern points to a superior labral (SLAP) tear or proximal biceps involvement because those structures are stressed more in the first position and relieved when the load shifts with the palm-up position.

Other tests focus on different issues: some emphasize thoracic outlet symptoms, others target general labral tears or biceps tendinopathy in different ways, but this maneuver is specifically used to identify superior labral pathology and proximal biceps impairment, making it the best choice here.