Speed’s test

Speed’s test is used in clinical practice to assess conditions related to the long head of the biceps tendon, particularly in cases of suspected bicipital tendinopathy or SLAP lesion (superior labrum anterior to posterior).¹ These conditions are common causes of anterior shoulder pain, and the test is useful for detecting irritation, inflammation, or structural damage to the biceps tendon.

Anatomical background

The long head of the biceps brachii passes over the humeral head through the intertubercular sulcus and is covered by synovial tissue. The tendon is stabilized by the transverse humeral ligament and the glenoid labrum. With overuse or trauma, one of the following may occur:

• Inflammation or degeneration of the biceps tendon (tendinopathy)

• Tear or lesion of the labrum in the superior part of the glenoid (SLAP lesion)²

Test procedure

Speed’s test is performed with the patient standing or seated. The test evaluates pain response during isometric loading of the biceps tendon in a vulnerable position.

Execution:

• The patient holds the arm in 90° shoulder flexion with full elbow extension

• The forearm is fully supinated (palm facing upward)

• The shoulder is slightly externally rotated

• The examiner places their hand on the patient’s wrist and applies downward resistance

• The patient maintains the isometric position while resisting the pressure

Interpretation of findings

• Positive test: Localized pain in the bicipital tendon or intertubercular sulcus, sharp and well-defined, indicates bicipital tendinopathy or possible SLAP lesion¹

• Negative test: Absence of pain reduces the likelihood of biceps tendon involvement, but does not fully rule it out

• Differential response: If pain is felt deep inside the shoulder joint rather than over the sulcus, a labral lesion may be suspected

Clinical evaluation

Although Speed’s test is simple and widely used, it has limited diagnostic precision. A positive test alone is not sufficient for a definitive diagnosis. Several studies have shown low sensitivity, and the test cannot independently distinguish between tendinopathy and labral injury.³

Clinical test characteristics for Speed’s test:³

• Sensitivity: 32%

• Specificity: 75%

• Positive likelihood ratio: 1.28

• Negative likelihood ratio: 0.91

These values indicate low sensitivity, but a negative test can be useful for excluding pathology, especially when combined with other assessments.

Use in a test battery

Speed’s test is often performed as part of a test battery, especially together with Yergason’s test. The combination provides higher diagnostic value when biceps pathology is suspected.⁴ Recommended clinical approach includes:

• Speed’s test (for anterior stress in flexion)

• Yergason’s test (for supination provocation)

• Palpation of the intertubercular sulcus

• Clinical history and diagnostic imaging when indicated

Evidence base and limitations

Speed’s test has shown good intra-examiner reliability but low isolated validity. Electromyography studies demonstrate activation of both the biceps brachii and surrounding stabilizing muscles during the test, which may influence interpretation in complex shoulder conditions. Therefore, Speed’s test is best applied as part of a comprehensive clinical assessment rather than as a standalone diagnostic tool.¹⁵

Summary

Speed’s test is a simple and rapid provocation test used in suspected biceps-related shoulder pain. It is most valuable when applied in combination with other clinical tests and thorough history-taking. Reliability and interpretation improve with correct technique and awareness of its limitations.

Sources:

1. Dutton M. Orthopaedic: Examination, Evaluation, and Intervention. 2. utg. New York: The McGraw-Hill Companies, Inc.; 2008.

2. Clinically Relevant. Speed's Test | Biceps Pathology. Tilgjengelig fra: https://members.physio-pedia.com/techniques/examination-techniques/?test=147 (sist åpnet 05.07.2025)

3. 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.