If you suspect a shoulder issue, especially involving the rotator cuff or biceps, Speed’s test can help you identify underlying problems. This simple yet effective clinical maneuver evaluates for bicipital tendinitis and other shoulder pathologies. Whether you’re a healthcare professional, a physical therapist, or someone experiencing shoulder discomfort, understanding how to perform and interpret Speed’s test can lead to more accurate diagnoses and targeted treatment plans. Before starting, ensure the patient is comfortable and understands the purpose of the test. Gather any necessary equipment such as a goniometer if you wish to measure movement angles, though it’s not essential for the basic test.
What You’ll Need
- Patient comfortable seated or standing
- Knowledge of shoulder anatomy
- Optional: Goniometer for measuring range of motion
Step-by-Step
- Explain the procedure to the patient, including that they may experience some discomfort if pathology is present, and ensure they are relaxed.
- Position the patient in a seated or standing position with the arm fully extended forward, palm facing upward (supination).
- Instruct the patient to elevate their arm to shoulder level, approximately 70 degrees of flexion, keeping the elbow extended.
- Support the patient’s elbow if needed to maintain the position, ensuring the arm remains in the flexed position.
- While the patient maintains this position, ask them to resist downward pressure applied gently at the wrist or forearm.
- Apply a slow, steady downward force, mimicking resistance, and observe the patient’s response.
- Note if the patient reports pain, especially a deep or anterior pain localized over the bicipital groove (the groove between the greater and lesser tubercles of the humerus).
- If pain is elicited, particularly in the bicipital groove, record this as a positive Speed’s test.
- Optionally, compare with the contralateral shoulder for symmetry and to assess the severity of discomfort.
Common Mistakes
- Performing the test with the arm not properly elevated to shoulder height.
- Applying excessive or uneven pressure, which can cause discomfort unrelated to pathology.
- Not supporting the elbow, leading to compensation or incorrect positioning.
- Failing to instruct the patient to resist appropriately, which can skew results.
- Ignoring patient feedback during the test, missing signs of pain or discomfort.
Tips
- Ensure the patient maintains the correct arm position, keeping the elbow extended and the arm elevated.
- Apply consistent, gentle pressure to avoid causing unnecessary pain or false positives.
- Perform the test on both shoulders for comparison.
- Use a slow, controlled motion to accurately gauge the patient’s response.
- Combine Speed’s test with other clinical assessments for a comprehensive evaluation.
Troubleshooting
If the test does not go as planned or yields inconclusive results, consider the following steps:
- Reassess the patient’s positioning—ensure the arm is correctly elevated and supported.
- Adjust the amount of pressure applied—too much force can cause pain unrelated to tendinitis.
- Perform the test in a different position or angle to verify results.
- Combine with other tests such as Yergason’s or Neer’s to improve diagnostic accuracy.
- If pain persists but no clear diagnosis emerges, refer the patient for imaging such as ultrasound or MRI.
Frequently Asked Questions
1. What does a positive Speed’s test indicate?
A positive Speed’s test suggests bicipital tendinitis or inflammation of the long head of the biceps tendon, especially if pain is localized in the bicipital groove.
2. Can Speed’s test differentiate between rotator cuff tears and biceps tendinitis?
Speed’s test primarily assesses the biceps tendon. For rotator cuff injuries, other tests like empty can or Neer’s are more appropriate.
3. How reliable is Speed’s test for diagnosing shoulder problems?
While useful, Speed’s test should be part of a comprehensive clinical evaluation, as it alone cannot confirm a diagnosis with complete certainty.
4. Should the test be painful for it to be considered positive?
Not necessarily. The key is whether the patient reports pain or discomfort in the bicipital groove during resistance, not just the presence of pain.
5. How can I reduce false positives or negatives?
Ensure proper technique, compare with the opposite shoulder, and combine findings with other clinical tests and patient history for the most accurate diagnosis.
6. Is Speed’s test suitable for self-assessment?
It’s best performed by trained clinicians. If you experience shoulder pain or suspect bicipital tendinitis, consult a healthcare professional for proper assessment.
Mastering Speed’s test enhances your ability to identify specific shoulder pathologies early, leading to better treatment outcomes. Practice the technique carefully, interpret results in context, and always consider the full clinical picture for accurate diagnosis and effective management.