Speed’s Test Unveiled: Step-by-Step Technique, Positive Groove Pain, and the Diagnoses It Signals

Shoulder pain ranks among the top five musculoskeletal complaints in primary-care and sports-medicine clinics. Because multiple structures share the same real estate—rotator-cuff tendons, the long head of the biceps, the labrum, and the subacromial bursa—a single imaging study seldom tells the full story. That is why special physical-exam maneuvers remain indispensable for zeroing in on the guilty structure. One of the most telling maneuvers for anterior shoulder pain is Speed’s Test. Properly executed, it acts like a spotlight on the long head of the biceps tendon and its attachment to the superior labrum.

This in-depth guide demystifies Speed’s Test, explains how to perform it without common pitfalls, clarifies what constitutes a positive result, and explores the diagnoses most often confirmed when groove pain lights up under your palpating fingertips.

Before gripping a patient’s wrist, picture the underlying structures:

Any swelling, fraying, or instability in these structures can sensitize mechanoreceptors, so resisted shoulder flexion instantly reproduces symptoms.

• Anterior shoulder pain that worsens when reaching overhead
• Localized tenderness along the bicipital groove on palpation
• Suspected biceps tendinitis/tendinopathy in throwing or overhead athletes
• Possible SLAP (Superior Labrum Anterior-Posterior) lesion after traction or fall on an outstretched arm
• Persistent pain despite negative impingement signs (Neer, Hawkins-Kennedy)

• Immediately post-op rotator-cuff or biceps surgery
• Acute shoulder dislocation or fracture
• Severe pain that prevents any active flexion—opt for imaging first

Tip: If the patient’s pain scale is ≥ 8/10 at rest, postpone provocative testing; false positives skyrocket in highly irritable shoulders.

Equipment required: Your hands and clinical judgment—no fancy devices needed.

1. Position the patient
   • Seated or standing upright, feet flat, core engaged.
   • Arm relaxed at the side, elbow fully extended (or ≤ 10° flexed).
   • Forearm supinated (palm forward).
2. Explain the maneuver
   • “I’m going to press down while you raise your arm straight in front. Tell me if you feel pain and where.”
3. Guide the movement
   • Ask the patient to actively flex the shoulder to 90 °.
   • Keep elbow extension and forearm supination throughout.
4. Apply resistance
   • Place your hand just proximal to the patient’s wrist.
   • With the other hand, palpate the bicipital groove.
   • Ask the patient to hold the position (“don’t let me push you down”) while you apply a steady downward force for 3–5 seconds.
5. Observe and ask
   • Watch facial cues; ask, “Any pain? Point to it.”
   • Note location, intensity, and reproduction of familiar symptoms.
6. Repeat bilaterally
   • Comparing sides helps control for pain threshold and dominant-arm strength differences.

• Sensitivity: 63 – 81 % (varies with examiner skill and patient population)
• Specificity: 32 – 75 %

Pairing with Yergason’s and O’Brien’s tests raises post-test diagnostic probabilities.

• Pathophysiology: Repetitive overhead motion → micro-tears → inflammation.
• Clinical pearls: Morning stiffness, pain when lifting a gallon of milk.
• Management: NSAIDs, eccentric-loading therapy, ultrasound-guided steroid if needed.

• Mechanism: Traction injury, throwing deceleration, or fall on outstretched hand.
• Red-flags: Clicking, catching, “dead arm” sensation during throwing.
• Confirmation: MR arthrogram → surgical repair in high-demand athletes.

• Etiology: Shallow groove, torn transverse humeral ligament, or rotator-cuff interval capsular laxity.
• Sign: Audible or palpable snap during arm rotation.
• Treatment: Physical therapy for rotator-cuff strengthening; surgical groove-deepening if recurrent.

1. History → overhead athlete? traumatic onset?
2. Inspection → swelling, Popeye deformity.
3. Palpation → groove tenderness.
4. ROM & Strength → active vs. passive limitations.
5. Special Tests
   • Anterior impingement (Neer, Hawkins)
   • Biceps stability (Speed, Yergason, Upper-Cut)
   • Labral stress (O’Brien, Crank)
6. Imaging → ultrasound for dynamic tendon-in-groove view; MRI for labrum.
7. Treatment plan → tailor to pathology and activity level.

• Systematic review (2024, J Shoulder Elbow Surg): Combining Speed with Yergason improved diagnostic odds ratio for SLAP tears by 2.1 × compared with either alone.
• Prospective cohort (2025, Sports Med): Athletes whose LHBT tendinitis was identified with Speed’s Test and treated via a structured eccentric program returned to play 28 % faster than MRI-only diagnosis group.
• Biomechanical study (2023, Clin Biomech): Forearm supination increases LHBT load by 45 % vs. pronation, validating test positioning.

“Your biceps tendon runs through a small groove in the front of your shoulder. By asking you to raise your arm while I press down, we stress that tendon. If it’s inflamed, you’ll feel a familiar pain right here (point). The result helps us decide whether therapy, imaging, or another treatment is the best next step.”

Clear explanations build trust, improve adherence to rehab, and reduce anxiety about further testing.

Always tailor to patient age, activity demands, comorbidities, and goals.

Repeat Speed’s Test every 2–4 weeks during rehab:

• Pain score drops ≥ 50 % → progress to sport-specific drills.
• Still positive at 12 weeks → consider imaging or surgical referral.

Objective re-testing keeps athletes honest about symptom improvement and flags lingering pathology before return to play.

Executed correctly, Speed’s Test is a low-tech yet high-yield maneuver for unmasking biceps tendon and superior-labral pathology. By mastering patient positioning, consistent resistance, and precise groove palpation, clinicians can transform a simple push-and-resist test into a powerful diagnostic ally. Pair it with corroborating special tests, imaging when warranted, and evidence-based rehabilitation to deliver faster, more accurate shoulder care—helping weekend warriors and elite athletes alike return to pain-free function.

• Keep elbow extension and forearm supination to maximize LHBT tension.
• Positive groove pain suggests biceps tendinitis, SLAP lesion, or instability.
• Combine Speed’s with Yergason’s and labral tests to boost diagnostic accuracy.
• Educate patients: understanding the test fosters adherence to rehab plans.
• Track Speed’s Test during follow-up to quantify recovery and guide return-to-play decisions.

Armed with this comprehensive playbook, you can press, resist, and diagnose with confidence—making Speed’s Test an integral part of your shoulder-assessment arsenal.

Also Read:

• Understanding the Importance of Speed’s Test in Modern Shoulder Evaluations