Test: Speed's Test (Shoulder)

Video Link

Background/Purpose

Speed's Test, also called the biceps tension test, is an orthopedic provocation test for pathology of the long head of the biceps tendon and the superior labrum. It was first described in the literature by Gilcreest and Albi (1939), who credited it to Dr. J. Spencer Speed. Speed reportedly noticed that patients felt anterior shoulder pain when he performed a straight leg raise with an outstretched arm. The test was originally intended to detect tenosynovitis of the long head of the biceps, but clinicians later extended it to partial biceps tears and superior labrum anterior-posterior (SLAP) lesions (Bennett, 1998; Holtby & Razmjou, 2004).




The mechanism is straightforward. With the shoulder flexed, the elbow extended, and the forearm supinated, a downward force makes the biceps tendon act like a suspension cable running from its attachment on the superior labrum, through the bicipital groove, to the arm. This loads both the intertubercular portion of the tendon and the biceps-labral anchor. The test is useful when evaluating anterior shoulder pain, suspected bicipital tendinopathy, and possible SLAP pathology. Its diagnostic accuracy is modest, though, and a positive result shifts post-test probability very little (Holtby & Razmjou, 2004; Hegedus et al., 2012). It also cannot reliably separate biceps tendinopathy from SLAP lesions, subacromial pathology, or AC joint pathology, all of which can cause anterior shoulder pain with resisted flexion. It is best used as part of a cluster that includes Yergason's test, O'Brien's active compression test, and bicipital groove palpation (Hegedus et al., 2012).




Sensitivity / Specificity:

Bennett (1998): sensitivity 90%, specificity 14% for biceps tendon pathology, in an arthroscopic study.

Holtby and Razmjou (2004): sensitivity 32%, specificity 75% for biceps pathology and SLAP lesions combined, in a prospective, blinded study of 152 patients with arthroscopy as the reference standard. Positive likelihood ratio 1.28, negative likelihood ratio 0.91.

Kibler et al. (2009): sensitivity 54%, specificity 81% for biceps tendon injury.

Hegedus et al. (2012): pooled sensitivity 20% and specificity 78% for SLAP lesions, in a meta-analysis.



Clinical note: A negative Speed's test does not rule out a SLAP lesion, and a positive test only modestly raises the probability of biceps or labral pathology (Holtby & Razmjou, 2004; Hegedus et al., 2012).




Suggested single values for the database field: Sensitivity 32%, specificity 75% (Holtby & Razmjou, 2004).




References:

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.

Gilcreest EL, Albi P. Unusual lesions of muscles and tendons of the shoulder girdle and upper arm. Surg Gynecol Obstet. 1939;68:903–917.

Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–978.

Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20(3):231–236.

Kibler WB, Sciascia AD, Hester P, et al. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37(9):1840–1847.

Procedure

The patient stands or sits upright. The tested arm is raised to 90° of shoulder flexion in the sagittal plane with the elbow fully extended and the forearm fully supinated (palm up). The clinician stands beside or in front of the patient, places one hand on the distal forearm, and may palpate the bicipital groove with the other hand. The clinician applies a steady downward force to the forearm while the patient resists and holds the position (Bennett, 1998).




A dynamic version is also commonly used. The clinician resists active shoulder flexion from 0° to 90° or higher. The test can also be repeated with the forearm pronated, since less pain in pronation supports a biceps source.




The test is positive if the patient reports pain in the bicipital groove or along the biceps tendon. Pain felt deep in the superior shoulder, or pain with clicking, may point to labral involvement. Record the pain location, which version was performed (static or dynamic), the effect of pronation, and any weakness compared with the uninvolved side.

Performed: Unilaterally

Dialog

"Hold your arm straight out, palm up. Resist as I push down. Tell me if you feel pain in the front of your shoulder."

Criteria

• No pain in the bicipital groove or along the biceps tendon.
• No deep superior shoulder pain or clicking suggesting labral involvement.
• Patient holds 90° of flexion against resistance without giving way.
• Resisted strength is equal to the uninvolved side.

Measurement

LOINC Code

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -