What is Speed’s Test?
The Speed’s test is a physical examination technique used to assess pathology of the long head of the biceps tendon and, secondarily, to screen for superior labral (SLAP) lesions. It is one of the most commonly performed shoulder tests in clinical practice and is frequently included alongside other biceps and labral assessment tools. The test applies resisted shoulder flexion with the elbow extended and forearm supinated, loading the biceps tendon and its attachment at the superior labrum. A positive result reproduces pain in the bicipital groove.
Quick Reference
| Also known as | Speed’s test, biceps tension test |
| Structure tested | Long head of biceps tendon, superior glenoid labrum |
| Patient position | Seated, shoulder flexed 60–90°, elbow extended, forearm supinated |
| Positive sign | Pain reproduced in the bicipital groove |
| Sensitivity (SLAP) | ~20% |
| Specificity (SLAP) | ~78% |
What Speed’s Test Assesses
Speed’s test was originally designed to identify tenosynovitis of the long head of the biceps tendon — inflammation of the tendon within its synovial sheath as it passes through the bicipital groove. Over time its clinical use expanded to include screening for SLAP lesions (Superior Labral Anterior to Posterior tears), which involve the attachment of the long head of the biceps at the superior glenoid labrum.
The test loads the biceps tendon by combining shoulder flexion, elbow extension, and forearm supination against resistance. This position places the biceps under tension from its distal insertion (radial tuberosity) through the bicipital groove to its proximal attachment at the superior labrum — stressing the full length of the tendon and its anchor point.
Anatomy: Long Head of the Biceps Tendon
The biceps brachii has two proximal tendon origins. The short head attaches to the coracoid process of the scapula. The long head originates from the supraglenoid tubercle and the superior glenoid labrum, travels through the shoulder joint, and exits through the bicipital groove of the humerus — held in place by the transverse humeral ligament.
This intra-articular course makes the long head of the biceps tendon uniquely vulnerable. As it passes through the groove and over the humeral head, it is subject to compression, friction, and tensile stress — particularly with overhead activity, repetitive loading, or in the presence of rotator cuff pathology that alters glenohumeral mechanics. Inflammation, fraying, or tearing of the tendon or its labral anchor can all produce anterior shoulder pain that worsens with resisted elbow flexion and forearm supination.
How to Perform Speed’s Test
Two versions of Speed’s test are described in the literature. Both share the same arm position; they differ in how resistance is applied.
Version 1 — Active Flexion Against Resistance (60°)
- The patient sits relaxed with the arm at their side, elbow fully extended, and forearm fully supinated.
- The examiner places one hand over the patient’s forearm to provide resistance.
- The patient actively flexes the shoulder from 0° toward approximately 60° against the examiner’s downward resistance.
- A positive result is pain in the bicipital groove during the resisted movement.
Version 2 — Resisted Hold at 90° (More Common)
- The patient sits with the shoulder positioned at approximately 90° of forward flexion, elbow fully extended, and forearm fully supinated.
- The examiner applies firm downward pressure over the patient’s forearm.
- The patient resists the downward force, maintaining the 90° position.
- A positive result is pain in the bicipital groove during the resisted hold.
The 90° resisted version is more widely used in clinical practice. In both versions, the forearm supination position is essential — it maximizes tension in the biceps tendon and concentrates loading at the proximal attachment.
Positive Sign and Interpretation
Speed’s test is considered positive when the patient reports pain specifically in the bicipital groove — the anterior shoulder region just medial to the deltoid — during resisted shoulder flexion. The provoked pain should match the patient’s familiar complaint.
Pain located elsewhere (top of the shoulder, posterior shoulder, or diffuse anterior pain) is less diagnostically meaningful and may reflect other pathology. Weakness without pain, or pain only at end range from capsular stretch, is not a positive finding.
Bicipital groove tenderness on palpation — assessed separately before or after the test — significantly increases confidence in a biceps tendon diagnosis when present alongside a positive Speed’s test.
Sensitivity and Specificity
Speed’s test has been studied in multiple systematic reviews, with diagnostic accuracy data varying based on the reference standard used and whether the target condition is biceps tendinopathy, SLAP lesion, or subacromial pathology.
| Target Condition | Sensitivity | Specificity |
|---|---|---|
| SLAP lesion | ~20% | ~78% |
| Biceps tendon pathology (general) | Moderate | Variable |
SLAP data from Hegedus et al. (2012), British Journal of Sports Medicine.
The low sensitivity for SLAP lesions is the most important clinical takeaway: Speed’s test misses approximately 80% of confirmed SLAP tears. A negative Speed’s test does very little to rule out labral pathology. Its moderate specificity means a positive result is modestly meaningful — but given the low sensitivity, a positive test cannot be over-interpreted without corroborating findings.
Speed’s test performs better as a biceps tendinopathy screen than as a SLAP test. In patients with clear bicipital groove tenderness and anterior shoulder pain aggravated by resisted supination, the clinical picture often carries more diagnostic weight than the test result alone.
Clinical Considerations
Limitations
- Speed’s test has poor sensitivity for SLAP lesions — a negative test does not exclude labral pathology. MRI arthrography remains the imaging reference standard for suspected SLAP tears.
- The test does not differentiate between biceps tendinopathy, SLAP tears, subacromial bursitis, or AC joint pathology — all of these can produce anterior shoulder pain with resisted flexion.
- False positives are common in patients with active subacromial impingement, as the forward flexion component of the test also loads the subacromial space.
- Examiner force consistency affects reproducibility. Standardizing the amount of resistance applied is difficult in clinical practice, which limits inter-rater reliability.
When to Use It
Speed’s test is most useful in the evaluation of patients presenting with:
- Anterior shoulder pain localized to the bicipital groove
- Pain with resisted elbow flexion or forearm supination
- History of overhead activity, throwing, or repetitive lifting
- Suspected SLAP lesion — particularly in overhead athletes with deep shoulder pain and a pop or catching sensation
- Biceps tendon rupture workup — Speed’s test is often negative after complete rupture due to loss of tension
Speed’s test is best used alongside Yergason’s test (which assesses biceps tendon stability in the groove) and bicipital groove palpation. When all three are positive together, clinical confidence for biceps tendon pathology increases substantially.
History and Eponym
Speed’s test is attributed to J. Herbert Speed, an American orthopedic surgeon who described the maneuver in the early 20th century as a clinical tool for identifying biceps tendon pathology. The original description focused on biceps tenosynovitis — inflammation of the tendon sheath — which was a recognized cause of anterior shoulder pain in active individuals. In subsequent decades, the test was adopted and modified by clinicians interested in labral pathology, extending its use to SLAP lesion screening despite its limited sensitivity for that purpose.
Related Shoulder Tests
- Yergason’s Test — resisted supination with elbow at 90°; assesses biceps tendon stability within the bicipital groove; often paired with Speed’s test
- O’Brien’s Test (Active Compression Test) — shoulder flexed to 90°, adducted 15°, internally rotated; assesses for SLAP lesions and AC joint pathology; better sensitivity for SLAP than Speed’s test
- Neer Test — passive forward flexion in internal rotation; assesses subacromial impingement
- Hawkins-Kennedy Test — shoulder and elbow at 90°, forcible internal rotation; subacromial impingement
- Empty Can Test — resisted abduction in scapular plane with internal rotation; assesses supraspinatus integrity
Frequently Asked Questions
What does a positive Speed’s test mean?
A positive Speed’s test — pain reproduced in the bicipital groove during resisted shoulder flexion with the elbow extended and forearm supinated — suggests pathology of the long head of the biceps tendon, which may include tendinopathy, tenosynovitis, or involvement of the superior glenoid labrum (SLAP lesion). A positive result raises clinical suspicion but should be interpreted alongside other findings, as the test lacks the specificity to confirm a diagnosis on its own.
How accurate is Speed’s test for SLAP lesions?
Not very. Speed’s test has approximately 20% sensitivity for SLAP lesions, meaning it correctly identifies only about 1 in 5 confirmed SLAP tears. A negative Speed’s test carries little diagnostic value for ruling out labral pathology. For suspected SLAP lesions, the O’Brien’s Active Compression Test generally performs better, and MRI arthrography is the preferred imaging reference standard.
What is the difference between Speed’s test and Yergason’s test?
Both tests assess the long head of the biceps tendon, but they stress it differently. Speed’s test loads the tendon through resisted shoulder flexion with the elbow extended — testing the full length of the tendon under tension. Yergason’s test uses resisted forearm supination with the elbow bent to 90° — primarily testing the tendon’s stability within the bicipital groove. The two tests are often performed together; a positive result on both strengthens the case for biceps tendon pathology.
Why does forearm supination matter in Speed’s test?
The biceps brachii is a powerful forearm supinator as well as an elbow flexor and shoulder flexor. Placing the forearm in full supination maximizes tension in the biceps muscle-tendon unit, concentrating the loading stress at the proximal tendon and its superior labral attachment. Testing with the forearm pronated or in neutral significantly reduces the mechanical load on the biceps and lowers the sensitivity of the test.
Can Speed’s test be positive with a rotator cuff tear?
Yes. Speed’s test can produce anterior shoulder pain in patients with subacromial impingement, rotator cuff tendinopathy, or subacromial bursitis — not just biceps or labral pathology. This is one reason its specificity is limited. Pain during the test that is anterior and located specifically at the bicipital groove is more diagnostically meaningful than diffuse anterior shoulder pain, which could reflect multiple structures.
Video Demonstration
> Return to the list of Orthopedic Tests of the Shoulder
Other tests you may be interested in:
- Full Can Test – supraspinatus integrity
- Neer Test – shoulder impingement
- O’Brien’s Test – glenoid labral tear