Biceps Load II Test

The Biceps Load II Test is used to identify SLAP lesions (Superior Labrum Anterior to Posterior) of the shoulder. These injuries affect the superior portion of the labrum, often at the attachment of the long head of the biceps tendon to the glenoid¹,².

Technique

The test is performed with the patient in a supine position:

• The shoulder is abducted to 120° and placed in full external rotation.

• The elbow is flexed to 90°, and the forearm is in supination.

• The patient is then instructed to actively flex the elbow against resistance applied by the examiner¹.

This position increases tension on the superior labrum and biceps anchor, making it possible to provoke symptoms in cases of SLAP pathology.

Positive Test

The test is considered positive if:

• The patient experiences pain during resisted elbow flexion, or

• The pain becomes worse during the maneuver¹.

Pain localized deep within the shoulder joint, often described as catching or discomfort, increases the suspicion of a SLAP lesion.

Diagnostic Accuracy

The diagnostic accuracy of the Biceps Load II Test has shown considerable variability in studies²:

Parameter	Value
Sensitivity	27.6%
Specificity	77.8%
Positive LR	1.24
Negative LR	0.93

Despite these values, the test has demonstrated a kappa coefficient of 0.815, indicating good inter-rater reliability¹.

Clinical Relevance

Although the Biceps Load II Test alone is not highly accurate, its diagnostic value increases significantly when used as part of a cluster of labral tests. Studies have shown that combining Biceps Load I, Biceps Load II, and O’Brien’s Test provides:

• Sensitivity: 99.2%

• Specificity: 99.9%⁴

This makes the test particularly valuable in evaluating patients with suspected SLAP lesions, especially in overhead athletes (e.g., throwers, baseball pitchers) and in individuals with recurrent shoulder instability.

In clinical practice, the test should be interpreted together with patient history, imaging when needed, and additional labral tests to ensure accurate diagnosis.

Summary

• Evaluates SLAP lesions involving the superior labrum and biceps anchor.

• Positive if pain is reproduced or worsens during resisted elbow flexion.

• Reliability is high, but sensitivity is low when used in isolation.

• Strongest diagnostic value when combined with other labral tests (Biceps Load I, O’Brien’s).

• Particularly relevant in overhead athletes and patients with instability symptoms.

References

1. Kim SH, Ha KI, Ahn JH, Kim SH, Choi HJ. Biceps load test II: a clinical test for SLAP lesions of the shoulder. Arthroscopy 2001 February; 17(2):160-164.

2. Somerville L, Willits K, Johnson A, Litchfield R, LeBel ME, Moro J, et al. Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions. The Surgery Journal. 2017 Oct;03(04):e154–62.

3. Clinically Relevant Technologies, http://www.youtube.com/watch?v=h2IyvaCEYpk; Accessed May 2011

4. Clark RC, Chandler CC, Fuqua AC, Glymph KN, Lambert GC, Rigney KJ. USE of CLINICAL TEST CLUSTERS VERSUS ADVANCED IMAGING STUDIES in the MANAGEMENT of PATIENTS with a SUSPECTED SLAP TEAR. International Journal of Sports Physical Therapy. 2019 Jun;14(3):345–52.