Speed's Test and Yergason's Test: Bicipital Tendon and Groove Assessment Guide
In short
Anterior shoulder pain frequently stems from the long head of the biceps tendon within the bicipital groove. Learn how Speed test and Yergason test differentiate biceps tendinopathy from rotator cuff tears and labral lesions.
In this guide (8 sections)
The Long Head of Biceps in Anterior Shoulder Pain
The long head of the biceps (LHB) tendon traverses an intra-articular route before exiting the glenohumeral capsule through the narrow bicipital groove (intertubercular sulcus), restrained by the transverse humeral ligament.
Repetitive overhead lifting, cricket bowling, or secondary subacromial impingement causes friction, tenosynovitis, and medial subluxation of the tendon.
How to Perform Speed's Test Correctly
Speed's test acts as a straight-arm resisted forward flexion test:
- Patient Arm Positioning: The patient extends their elbow fully, supinates the forearm (palm facing up), and forward elevates the arm to approximately 90 degrees.
- Clinician Resistance: The clinician places one hand over the bicipital groove to palpate the tendon and the other hand on the patient distal forearm, pressing downward while the patient resists.
- Positive Test: Sharp localized pain reproduced directly in the bicipital groove indicates biceps tendonitis or tendinopathy.
Yergason's Test for Transverse Ligament Stability
While Speed test assesses tendon inflammation, Yergason test specifically evaluates transverse humeral ligament integrity:
The patient stands with elbow flexed to 90 degrees and forearm fully pronated (palm down), tucked against their waist. The patient attempts to simultaneously supinate the forearm and externally rotate the arm against firm clinician resistance. If the biceps tendon pops out of the bicipital groove with a palpable click, transverse humeral ligament rupture or subluxation is confirmed.
Comparative Diagnostic Values
| Examination Test | Sensitivity | Specificity | Primary Diagnostic Value | |
|---|---|---|---|---|
| Speed's Test | 63 to 90 percent (Moderate to High) | 46 to 74 percent (Moderate) | High sensitivity; excellent initial screening tool | |
| Yergason's Test | 32 to 43 percent (Low) | 79 to 95 percent (High) | High specificity; rules in transverse ligament rupture | |
| Bicipital Groove Tenderness | 85 percent | 42 percent | High sensitivity; tender to direct palpation |
Frequently Asked Questions
What if Speed test causes pain at the top of the shoulder rather than the front?
Pain on top of the shoulder at the acromioclavicular (AC) joint or deep posterosuperior glenoid suggests a SLAP tear or AC joint arthrosis rather than isolated bicipital groove tenosynovitis.
How do physiotherapists treat long head biceps tenosynovitis?
Treatment includes temporary avoidance of overhead loading, eccentric biceps tendon conditioning in supination, rotator cuff dynamic stabilization, and addressing thoracic kyphosis.
Biceps Pulley Lesions and Instability Mechanics
The long head of the biceps tendon travels through the intertubercular bicipital groove, stabilized by the transverse humeral ligament and fibers of the subscapularis and supraspinatus tendons forming the biceps pulley. Tears of the subscapularis tendon permit the biceps tendon to subluxate medially out of its bony groove, creating painful mechanical clicking.
Conservative Load Progression for Biceps Tendinopathy
Active physiotherapy begins with isometric bicep loading at 90 degrees of elbow flexion with the forearm supinated. As tolerance improves, patients transition to slow eccentric bicep curls and seated cable rows to reinforce the posterior rotator cuff.
Workplace and Domestic Loading in India
Carrying heavy grocery bags (tholis) with flexed elbows, lifting filled water vessels, and gripping motorcycle accelerator throttles in heavy traffic exacerbate proximal biceps inflammation. Distributing weight evenly across the forearm reduces direct tendon strain.
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