Yergasons Test
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Purpose
The Yergason's Test is used to test for biceps tendon pathology, such as bicipital tendonitis and an unstable superior labral anterior posterior (SLAP) lesion. [1]
Technique
The patient should be seated or standing in the anatomical position, with the humerus in a neutral position and the elbow in 90 degrees of flexion in a pronated position. The patient is asked to externally rotate and supinate their arm against the manual resistance of the therapist produced by wrapping the hand around the distal forearm (just above the wrist joint). [2]
Yergason's Test is considered positive if the pain is reproduced in the bicipital groove and a biceps or a SLAP lesion is suspected. If a "clicking" sensation familiar to the patient is produced during the test, damage to the transverse humeral ligament (which overlies the intertubercular sulcus) should be suspected as well. [1]
Evidence
| Sensitivity | 0.43 |
| Specificity | 0.79 |
| Positive Likelihood Ratio | 2.05 |
| Negative Likelihood Ratio | 0.72 |
A meta analysis by Hegedus et al[5] did find that Yergason's test had the highest specificity (95%) but a low specificity where as the LR+ shows that the test is not able to rule in a SLAP lesion when it is positive.
Test Item Cluster: The Yergason's Test is often combined with the Speed's Test to detect bicipital tendonitis.
See test diagnostics page for explanation of statistics.
Clinical Context
The test was devised in 1931 for detecting bicipital tendonitis. Dr. Yergason published a case study about someone having increased pain in the bicipital groove with resisted supination while the forearm was in pronation[6]. There is a limitation with the original paper because the technique used was neither described or illustrated. It is however now clear that the pain may arise from tenosynovitis, tendinopathy, or a SLAP lesion. It also assesses the ability of the transverse humeral ligament to hold the biceps tendon in the bicipital groove. The biceps tendon is associated with isolated overuse injury in youths and rotator cuff disease in the elderly. [1]
The test has been found to be more useful in diagnosing SLAP lesions than biceps diseases.
Variations
A common variation of the test is described as the patient moving the shoulder into external rotation while simultaneously moving the forearm into the supine position against resistance. It is a complex movement and the patient is encouraged to perform it without resistance first so they can elicit an effective response when resistance is added. Robert Pettitt[7] performed a systematic review of the different variations which he proposed lead to differences in the ability to diagnose a transverse humeral ligament rupture.
Clinical Tip
Once the elbow has been stabilised by the therapist, the free hand can palpate over the intertubercular sulcus (bicipital groove) to detect any unusual subluxation, 'clicking', or 'snapping' during the test.
Related Tests
The following are similar to Yergason's test: [1]
- Lippman's test
- Gilchrest's sign
- Heuter's sign
- Ludington's test
References
- ↑ 1.0 1.1 1.2 1.3 Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010.
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ Clinical Physio. Yergason's Test | Clinical Physio. Available from: https://www.youtube.com/watch?v=KxuskHhckK0&ab_channel=ClinicalPhysio (Last accessed 24/09/2024).
- ↑ Holtby R, Razmjou H. Accuracy of the Speed's and Yergason's test in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2004: 20(3):231-236.
- ↑ Hegedus, E. J., Goode, A. P., Cook, C. E., Michener, L., Myer, C. A., Myer, D. M., & Wright, A. A. (2012). 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. British journal of sports medicine, 46(14), 964–978. https://doi.org/10.1136/bjsports-2012-091066
- ↑ Yergason RM. Supination sign. J Bone Joint Surg Br 1931;13:16
- ↑ Pettitt, R. W., Sailor, S. R., Lentell, G., Tanner, C., & Murray, S. R. (2008). Yergason's Test: Discrepancies in Description and Implications for Diagnosing Biceps Subluxation. Athletic Training Education Journal, 3(4), 143-147