Yergasons Test: Purpose, Test Details & Results

Shoulder pain and dysfunction are common complaints in clinical practice, often stemming from complex structures like the biceps tendon and labrum. Yergason’s test is one of the classic physical examination maneuvers used to assess injuries or pathologies related to these tissues. But how effective is it? What exactly does the test involve? And how should its results be interpreted? This article explores the purpose, procedure, and clinical value of Yergason’s test, synthesizing the latest evidence to help clinicians and patients understand its role in shoulder assessment.

Purpose of Yergason's Test

Understanding why Yergason’s test is performed is crucial for both clinicians and patients. This physical examination maneuver targets specific anatomical structures in the shoulder and is used to help diagnose certain injuries. But what does it actually aim to reveal, and what conditions is it most useful for?

What Is Yergason's Test For?

Yergason’s test is primarily designed to detect pathology in the long head of the biceps tendon, particularly at its origin where it attaches to the glenoid labrum of the shoulder. This includes:

• Biceps tendinopathy: Inflammation or degeneration of the tendon.
• Biceps tendon tears: Partial or complete disruptions.
• SLAP lesions: Injuries to the superior labrum from anterior to posterior, often involving the biceps anchor 1 2 4 5.

Why Is It Used?

The main clinical scenarios for using Yergason’s test include:

• Patients presenting with anterior shoulder pain, especially if pain is localized to the bicipital groove.
• Suspected SLAP lesions, which are common in athletes and individuals with a history of overhead activities or trauma.
• Differentiating biceps pathology from other sources of shoulder pain, such as rotator cuff disease 1 2 3.

Limitations of Its Purpose

While Yergason’s test is a widely taught and commonly used maneuver, its diagnostic value is modest. Studies consistently show that while it can help point toward biceps or labral pathology, it should not be used as a stand-alone diagnostic tool. Its specificity is higher than its sensitivity, meaning it is better at ruling in disease when positive than ruling it out when negative 1 2 3 4.

Yergason's Test Details

It’s one thing to know what Yergason’s test is for—but how is it actually performed? What does a positive result look like, and what should the clinician watch for during the test? Understanding the procedural details is key for proper execution and interpretation.

Step-by-Step Procedure

1. Patient Positioning

• The patient should be seated or standing, with the elbow flexed to 90 degrees and the forearm pronated (palm facing downward) 1 2 3.
• The upper arm should be stabilized against the torso to isolate the biceps.

2. The Maneuver

• The examiner holds the patient’s forearm and asks the patient to actively supinate the forearm (turn the palm upwards) against resistance, while also externally rotating the shoulder.
• The examiner provides resistance to both supination and external rotation 1 2 3.

3. Observing for a Positive Test

• Pain or tenderness localized to the bicipital groove suggests biceps tendon pathology.
• Palpable or audible snapping may indicate subluxation of the biceps tendon, often due to a tear in the transverse humeral ligament.
• Sometimes, a “popping” sensation is reported by the patient 1 2 3 4.

Interpretation of Findings

• Pain alone: May suggest biceps tendinopathy or SLAP lesion.
• Snapping/popping: More specific for subluxation or dislocation of the biceps tendon.
• No symptoms: Does not rule out pathology, especially given the test’s limited sensitivity 1 2 3 4.

Practical Tips

• Always compare both sides for baseline differences.
• Combine with other shoulder tests (like Speed’s, O’Brien’s, or Crank test) for a more comprehensive assessment 2 3 5.
• Document the precise location and quality of symptoms elicited during the maneuver.

Yergason's Test Results & Follow-Up

Interpreting the results of Yergason’s test can be nuanced. What does a positive or negative test really mean for patient care? How reliable is it, and what are the next steps after the test? Here, we summarize and explain the evidence on diagnostic accuracy and recommended follow-up.

Diagnostic Accuracy: What Do the Numbers Say?

• Sensitivity: Ranges from 32% to 43%—meaning the test misses many true cases of biceps or SLAP pathology.
• Specificity: Ranges from 75% to 95%—a positive test is relatively good at ruling in disease, especially SLAP lesions 1 3 4.
• Positive Predictive Value: Moderate (about 60%), so a positive test increases the probability of disease but is not definitive.
• Negative Predictive Value: Also moderate (about 65%), so a negative test does not reliably rule out disease 1 3 4.

Likelihood Ratios:

• Positive likelihood ratio (PLR) for Yergason’s test: approximately 2.0–2.3, which can increase the probability of disease but not to a level sufficient for a definitive diagnosis 1 2 4.
• Negative likelihood ratio (NLR): around 0.7, which means a negative result does not substantially lower the probability of disease 1 3 4.

Combining Tests: Improving Diagnostic Value

• Studies show that combinations of shoulder physical exam maneuvers (e.g., Yergason’s plus anterior slide test) improve diagnostic specificity, especially when all are positive (“series” testing) 5.
• Combining positive results across different tests can help rule in SLAP lesions, but sensitivity remains limited 3 5.

Limitations and Clinical Implications

• No single physical examination test, including Yergason’s, can reliably diagnose SLAP lesions or biceps pathology in isolation 3 4 5.
• Clinical context is key: History, mechanism of injury, and other examination findings must be considered.
• Imaging (MRI, ultrasound) or arthroscopy may be required for definitive diagnosis in cases with persistent symptoms or unclear findings 1 3 4.

Follow-Up After Yergason’s Test

• Positive test: Consider further workup, including imaging, especially if symptoms are severe or disabling.
• Negative or inconclusive test: Do not exclude pathology. Continue with a thorough exam and consider diagnostic imaging if clinical suspicion remains high.
• Rehabilitation or referral: For confirmed cases, referral to physical therapy or orthopedic specialist may be indicated.

Conclusion

Yergason’s test remains a useful component of the shoulder physical examination, but it is not a stand-alone diagnostic tool. Here’s what you need to remember:

• Purpose: Designed to detect biceps tendon and SLAP lesions by provoking pain, tenderness, or instability in the bicipital groove 1 2 3 4.
• Procedure: Involves resisted supination and external rotation at the elbow and shoulder, with pain or snapping indicating possible pathology 1 2 3.
• Results: A positive test has moderate-to-high specificity but low sensitivity; it is most useful for ruling in, not ruling out, disease 1 3 4.
• Clinical Use: Always interpret in context with other tests and patient history. Imaging or arthroscopic confirmation may be necessary 3 4 5.

Summary of Key Points:

• Yergason’s test targets biceps and labral pathology, especially SLAP lesions 1 2 3 4.
• The maneuver involves resisted supination and external rotation with elbow flexed 1 2 3.
• Positive findings (pain, snapping) suggest biceps or labral injury, but negative findings do not rule them out 1 3 4.
• Diagnostic accuracy is limited; combine with other tests and clinical information 3 4 5.
• Follow-up with imaging or specialist referral is often required for definitive diagnosis 1 3 4.

By understanding the strengths and limitations of Yergason’s test, clinicians can better integrate it into a comprehensive shoulder assessment, ensuring patients receive accurate evaluation and appropriate care.