Yergason's Test

What is Yergason’s test?

Yergason’s test is a physical test performed to help detect certain biceps tendon injuries — in particular, an injury to the long head of the biceps tendon. It can also assist in the diagnosis of a tear in your transverse humeral ligament, SLAP tear and biceps tendonitis.

Where is your biceps muscle?

Your biceps muscle is located on top of each of your upper arms (humerus). It’s the muscle that you see when you “flex your muscles.” Your biceps muscles help you lift objects, bend your elbow and reach over your head.

Where is the long head of the biceps tendon?

Tendons attach muscles to bone. You have three biceps tendons. Two tendons attach your biceps muscle to your shoulder joint. The long head of the biceps tendon attaches to the top of your shoulder socket (glenoid). The short head of the biceps tendon attaches to the coracoid process of your shoulder blade. (Your third tendon attaches your biceps muscle to your radius bone at your elbow.)

What is your transverse humeral ligament?

Your transverse humeral ligament is a short, wide horizontal ligament that lays horizontally across the long head of the biceps tendon on the “ball” of the humerus. This ligament encloses the long head of the biceps tendon and keeps it in a groove (called the bicipital groove) during shoulder movement.

What is a SLAP tear (also called SLAP lesion)?

SLAP is an acronym for superior labrum anterior to posterior tear. Your labrum is a ring of cartilage around the outside edge of your glenoid cavity. The glenoid cavity is the end of your shoulder blade (scapula) into which the top of your upper arm (humerus) rests. It’s the “socket” of your upper arm shoulder “ball and socket” joint. A SLAP tear is an injury — a fray, tear or detachment — of the labrum. The long head of the biceps tendon attaches to the top of the labrum. Therefore an injury to the labrum may also cause an injury to the long head of the biceps tendon.

What is biceps tendonitis?

Biceps tendonitis is inflammation or irritation of your upper biceps tendons. Damage is caused by continuous or repetitive actions that result in the overuse of your tendons. Years of wear and tear can cause your biceps tendon to become inflamed.

How is Yergason’s test performed?

You’ll stand or sit will your arms next to your side, in their natural position with the back of your hand facing forward. Next, you’ll bend (flex) your forearm (lower arm) upward at the elbow to a 90-degree angle, keeping your elbow and upper arm close to the side of your body. Make sure that the palm of your hand continues to face the floor.

Your healthcare provider will place the fingers of one of their hands on the edge of the front part of your shoulder. This is so they can feel the bicipital groove where the transverse humeral ligament and the long head of the biceps tendon are located. Their other hand will gently grasp your forearm to provide some resistance as you move your arm during the test.

Next, you’ll be asked to perform two movements. While keeping your elbow tight to your side, rotate your forearm so that the palm of your hand faces up while at the same time moving your forearm outward away from your body.

Your provider will repeat this test on your “good” arm for comparison.

What’s a positive Yergason’s test?

If your transverse humeral ligament is torn, your provider will feel a clicking or a snapping sensation under their fingers that are positioned on your shoulder. This is the long head of the biceps tendon popping out of the bicipital groove because the transverse humeral ligament is no longer holding it in place.

The test is also considered positive if you feel pain or tenderness during the test. Pain or tenderness may indicate tendinopathy (long-term tendon injury), tendinosis (breakdown of the collagen in the tendon) or SLAP tears.

How accurate is this test?

Yergason’s test has a sensitivity of 43% and a specificity of 79% for detecting problems with your biceps tendon.

What do the sensitivity and specificity of a test mean?

Sensitivity is the ability of a test to correctly identify people who have the condition (and the number of false negatives is low. “False negatives” are people who actually do have the condition but the test indicates they don’t). Specificity is the ability of a test to correctly identify people who don’t have the condition (and the number of false positives is low. “False positives” are people who don’t have the condition but the test indicates they do).

The higher the percentage of each of these values — out of 100% — the more accurate the test is in diagnosing your condition.

What are the next steps after this test?

Your healthcare provider may:

• Perform other quick physical tests (see “additional common questions” below).
• Order diagnostic imaging tests, such as magnetic resonance imaging (MRI).

They may also recommend:

• Rest.
• Ice.
• Anti-inflammatory medications.
• Cortisone shots.
• Physical therapy.
• Debridement (surgical removal of frayed, torn or floating tissues) within the shoulder joint.
• Other surgeries, including biceps tenotomy or tenodesis, depend on the cause.

What is a Speed’s test?

Speed’s test is a physical test performed to help detect certain biceps tendon injuries, including injury to the long head of the biceps tendon, presence of SLAP tears or tendinopathy in your shoulder.

How is Speed’s test performed?

You’ll stand with your arm next to your side with the palm of your hand facing forward. Without bending your elbow, begin to raise your arm toward your head in a semi-circular motion (like you’re bowling) until it’s parallel to the height of your shoulder (90-degree angle).

While you are performing this movement, your provider will place one hand on your forearm to provide a little resistance as you raise your arm. (Their other hand will be on your shoulder blade.)

Variation 1. In this variation of Speed’s test, the test begins with your arm already fully extended, parallel to the height of your shoulder (or lower positions) with the palm of your hand facing up. Your provider will then place one hand on your forearm and apply some resistance as you continue to raise your arm.

Variation 2. If you experience too much pain to perform either method of Speed’s test, there’s another option. You’ll stand will your arms next to your side with the back of your hand facing forward. Without bending your elbow, begin to raise your entire arm toward your head in a semi-circular motion until it’s parallel to the height of your shoulder (90-degree angle).

While you are performing this movement, your provider will place one hand on your forearm to provide a little resistance as you raise your arm. (Their other hand will be on your shoulder blade.)

This variation reproduces the same movement but the long head of the biceps tendon is less active in this position. If you experience more pain and weakness when performing the movement with the palm of your hand facing up, compared to when your palm is facing down, this gives strength to the finding that there’s a problem with the long head of the biceps tendon.

Your provider will repeat one or more of these variations on your “good” arm for comparison.

What’s a positive Speed’s test?

You have a positive test if you experience pain or weakness during this test. Pain indicates a long head of the biceps tendonitis or a SLAP lesion. If you experience weakness (you can’t generate power through the test), you may have a tear in the long head of the biceps tendon.

How accurate is Speed’s test?

Speed’s test has a sensitivity of 32% and a specificity of 75% for detecting problems with your biceps tendon.

What is O’Brien’s test?

O’Brien’s test is a physical test performed to help detect certain biceps tendon injuries, including injury to the long head of the biceps tendon and SLAP lesions.

How is O’Brien’s test performed?

You’ll stand or sit with your arm next to your side with the palm of your hand facing forward. Without bending your elbow, raise your arm toward your head in a semi-circular motion (like you’re bowling) until it’s parallel to the height of your shoulder (90-degree angle). Move the angle of your fully extended arm slightly inward toward the center of your body (about a 10-degree adduction). Rotate your hand so that your thumb faces down and the palm of your hand faces away from your body.

Your provider will ask you to resist the downward pressure they apply to the top of your forearm.

Now rotate your forearm so that the palm of your hand faces up. Again, resist the downward pressure your provider applies to the top of your forearm.

Your provider will repeat this test on your “good” arm for comparison.

What’s a positive O’Brien’s test?

You have a positive test if you experience pain during this test. Pain at the shoulder joint suggests a SLAP lesion. If you experience decreased pain when the palm of your hand was facing up, this adds to the strength of finding that you have a SLAP lesion.

How accurate is O’Brien’s test?

O’Brien’s test has a sensitivity of 38% and a specificity of 61% for detecting SLAP lesions.

A note from Cleveland Clinic

Yergason’s test is a quick and simple physical test to help detect certain biceps tendon injuries. In particular, the test aids in the detection of an injury to the long head of the biceps tendon. It can also assist in the detecting of a tear in your transverse humeral ligament, SLAP tear and biceps tendonitis. If your Yergason’s test is positive, your provider may perform other arm movement tests to strengthen the finding. Together, you and your provider will discuss other methods to confirm the diagnosis and then develop a treatment plan, which will include conservative treatments (rest, ice, medications, physical therapy) and surgical options if they’re needed.