Habermeyer Supine Flexion Resistance Test for SLAP Lesions
What Is the Habermeyer Supine Flexion Resistance Test?
The Habermeyer Supine Flexion Resistance Test is a shoulder examination maneuver used to assess suspected injury involving the superior labrum–biceps tendon complex. It is primarily associated with evaluating SLAP lesions, particularly type II injuries. SLAP refers to a superior labral injury extending from anterior to posterior around the attachment of the long head of the biceps tendon.
The maneuver involves resisted movement of the arm from an overhead position while the patient lies on an examination table. Reproduction of deep shoulder pain raises suspicion of pathology involving this region. However, a positive test does not independently confirm a SLAP tear. Its findings must be interpreted alongside the patient’s history and the rest of the shoulder examination.
What Is the Test Used For?
The Habermeyer Supine Flexion Resistance Test helps clinicians investigate whether the superior labrum–biceps complex may contribute to shoulder symptoms. It provides an additional provocative maneuver when a labral injury is suspected.
Its clinical purpose is to reproduce symptoms under a specific loading condition. This is different from establishing the complete diagnosis: the location of pain, circumstances in which symptoms occur, and findings from other examination maneuvers remain relevant.
A systematic review of SLAP diagnosis highlighted considerable variation in how clinicians combine history, examination, imaging, and arthroscopic findings. This supports interpreting the test as one component of a broader assessment rather than treating any single painful maneuver as definitive evidence of a tear.
How to Perform the Habermeyer Supine Flexion Resistance Test
Patient Position
The patient lies supine, facing upward on the examination table. Both arms are elevated overhead until they rest on the table, with the palms facing upward.
Examiner Position
The examiner stands beside the shoulder being assessed and places a hand around the patient’s arm immediately below the elbow.
Testing Maneuver
- Ask the patient to lift the affected arm away from the table from its overhead starting position.
- Apply opposing resistance through the hand positioned below the elbow.
- Ask the patient whether the movement reproduces shoulder pain.
- Identify whether the pain is deep within the joint or situated along the posterior joint line.
The essential feature is resisted arm movement from the overhead position, rather than isolated resisted elbow flexion. What is SLAP Lesion?
What Is a Positive Result?
A positive Habermeyer Supine Flexion Resistance Test produces pain deep within the shoulder or along the posterior joint line during the resisted maneuver. These symptoms suggest possible involvement of the superior labrum–biceps tendon complex. What is SLAP Lesion?
The result should be described as suggestive of a SLAP lesion, rather than proof that one is present. This distinction matters because the test has imperfect specificity: some patients without the target lesion can also have a positive result. Similarly, a negative finding cannot completely exclude a tear because sensitivity is below 100%.
Diagnostic Accuracy
Ebinger and colleagues evaluated the supine flexion resistance test against arthroscopic findings and compared it with Speed’s test and the O’Brien test. Their 2008 study reported the following results:
| Diagnostic measure | Reported result |
|---|---|
| Sensitivity in the overall study population | 80% |
| Specificity in the overall study population | 69% |
| Sensitivity for isolated SLAP lesions | 92% |
These figures describe performance within the study population. They should not be interpreted as a universal accuracy rate or as the probability that an individual patient has a tear.
For example, 80% sensitivity means that the test identified approximately eight out of ten affected patients in that study. Specificity of 69% indicates that false-positive findings remained possible. The higher sensitivity reported for isolated lesions should not be substituted for the overall estimate when discussing patients with mixed shoulder pathology.
How Does It Fit Into a Shoulder Examination?
Clinicians may consider other provocative maneuvers, including the O’Brien active compression test, Speed’s test, and other labral assessments, when evaluating suspected SLAP pathology.
A 2023 systematic review and meta-analysis found that the way examination tests are combined affects diagnostic performance. Requiring all tests in a combination to be positive generally improved specificity, while accepting any positive test generally improved sensitivity.
This does not mean that every combination has equal value. It also does not establish a validated diagnostic cluster specifically containing the Habermeyer test. Instead, it illustrates why clinicians should consider the pattern of findings and understand the limitations of the maneuvers they select.
Persistent clinical suspicion may justify further evaluation, including appropriate imaging. Decisions should follow the overall clinical assessment rather than the result of this test alone.
Frequently Asked Questions
What does the Habermeyer Supine Flexion Resistance Test assess?
It assesses suspected pathology of the superior labrum–biceps tendon complex and is used during evaluation for SLAP lesions.
Where is pain felt during a positive test?
The characteristic finding is pain deep inside the shoulder joint or along the posterior joint line during resisted movement from the overhead position.
Does a positive result confirm a SLAP tear?
No. A positive result increases clinical suspicion but requires correlation with the history, other examination findings, and further investigations when appropriate.
Is using several shoulder tests better than using one?
Combining tests can change sensitivity and specificity, but the benefit depends on which tests are selected and how their results are interpreted. Multiple positive findings should still be assessed within the patient’s overall clinical presentation.
References
- Ebinger N, Magosch P, Lichtenberg S, Habermeyer P. A new SLAP test: the supine flexion resistance test. Arthroscopy. 2008;24:500–505. PubMed
- Dean RS, Onsen L, Lima J, Hutchinson MR. Physical Examination Maneuvers for SLAP Lesions: A Systematic Review and Meta-analysis of Individual and Combinations of Maneuvers. American Journal of Sports Medicine. 2023;51(11):3042–3052. PubMed
- Kibler WB, Sciascia A. Current Practice for the Diagnosis of a SLAP Lesion: Systematic Review and Physician Survey. Arthroscopy. 2015;31(12):2456–2469. PubMed
- OrthoFixar. Biceps Load Test: Habermeyer Supine Flexion Resistance Test. OrthoFixar