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Abstract & Commentary
Synopsis: Speed’s test is not specific but is a sensitive indicator of either biceps or labral shoulder pathology.
Source: Bennett WF. Specificity of the Speed’s test: Arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy 1998;14(8):789-796.
The speed’s test usually suggests inflammation or trauma to the biceps tendon or the bicipital labral complex. Bennett analyzed 46 shoulders in 45 patients over a five-month period. The Speed’s test was performed preoperatively, and the correlation with pathology encountered at the time of arthroscopy by direct visualization, as well as with a probe, was noted. Of the 46 shoulders that were evaluated, the Speed’s test was positive in 40 shoulders.
Biceps and/or labral pathology was present in 10 of these patients. This resulted in a specificity of 13.8% and sensitivity of 90%. Bennett concluded that the Speed’s test is a nonspecific test but sensitive for macroscopic bicipital-labral pathology. Bennett also noted that the test was positive in a number of other intrinsic pathological lesions of the shoulder.
Speed’s test was first described by J. Spencer Speed, MD, of the Campbell Clinic. However, it has been in wide clinical use for years, and it is one of the few tests used to isolate biceps tendon pathology. It is performed with the patient’s shoulder forward flexed 90°, elbow fully extended, and the forearm supinated. The examiner then gives resistance to the arm at the level of the forearm as the patient actively forward flexes the shoulder.1 If pain is reproduced anteriorly, this is felt to be a positive Speed’s test.
The biceps tendon is in close proximity to a number of components of the rotator cuff. A false-positive Speed’s test may be present in a number of pathological lesions of the shoulder. Recently, there have been some tests described by O’Brien and others to attempt to identify SLAP lesions in the shoulder, which also appear to have a high percentage of surgical patients showing positive tests.2-5 The specificity and sensitivity of this test has been reported by a number of authors and is quite varied. The take-home message from this article is that a Speed’s test should be performed while doing a complete shoulder examination, and a positive test will probably indicate the presence of biceps tendon pathology but may also indicate a number of other pathological lesions, many of which affect anterior shoulder structures.
1. Canale ST, et al. Campbell’s Operative Orthopaedics. 9th ed. 1:784.
2. Liu SH, et al. A prospective evaluation of a new physical examination in predicting glenoid labral tears. Am J Sports Med 1996;24:721-725.
3. Kibler WB. Specificity and sensitivity of the anterior slide test and throwing athletes with superior glenoid labral tears. Arthroscopy 1995;11:296-300.
4. Clark JM, Harriman DT III. Tendons, ligaments and capsule of the rotator cuff: Gross and microscopic anatomy. J Bone Joint Surg 1992;74A:713-725.
5. Walch G, et al. Tear of the supraspinatus tendon associated with hidden lesions of the rotator interval. J Shoulder Elbow Surg 1994;3:353-360.