Speed’s Test is commonly used to assess long head of biceps tendon involvement and anterior shoulder pain provocation during resisted shoulder flexion. This article outlines the protocol, interpretation, limitations and practical assessment considerations.

Introduction

Anterior shoulder pain can arise from multiple structures including:

• long head of biceps tendon
• labral structures
• rotator cuff
• glenohumeral joint irritation

Speed’s Test is one of several shoulder orthopaedic assessments used to provoke symptoms associated with the long head of the biceps tendon during resisted shoulder flexion.

It is commonly used alongside:

• O’Brien’s Test
• Yergason’s Test
• palpation of the bicipital groove
• shoulder ROM assessment
• loading and strength testing

A positive test may increase suspicion of biceps tendon involvement, but it does not independently confirm pathology.

Quick Summary

• Primary purpose: Assess long head of biceps tendon symptom provocation
• Body region: Shoulder
• Commonly associated with: Biceps tendinopathy or anterior shoulder irritation
• Positive finding: Pain in anterior shoulder or bicipital groove during resistance
• Negative finding: No symptom reproduction
• Clinical role: Supports anterior shoulder assessment reasoning
• Best interpreted with: Palpation and other biceps/labral tests

What Is Speed’s Test?

Speed’s Test is a resisted shoulder assessment where the arm is positioned in flexion with elbow extended and forearm supinated, then resisted to assess anterior shoulder symptom provocation.

The test is intended to:

• load the long head of biceps tendon
• reproduce anterior shoulder pain
• assess tendon irritability
• support clinical reasoning in anterior shoulder pain presentations

Why It Is Used

Speed’s Test may help:

• identify biceps tendon irritation
• reproduce anterior shoulder pain
• assess load tolerance in shoulder flexion
• support anterior shoulder test clusters
• guide exercise modification

It may be particularly relevant in:

• throwing athletes
• gym-based populations
• overhead athletes
• clients with anterior shoulder pain
• clients with pain during pulling or lifting

What It Measures

The test evaluates:

• long head biceps tendon sensitivity
• anterior shoulder pain response
• load tolerance during resisted flexion
• tendon irritability under tension

A positive finding may suggest biceps tendon involvement, but does not confirm structural tearing or labral pathology independently.

Who It Is Useful For

Speed’s Test may be useful for:

• exercise professionals
• sports performance settings
• allied health assessment environments
• shoulder screening
• overhead athlete monitoring
• movement assessment education

When to Use This Test

Consider using Speed’s Test when a client reports:

• anterior shoulder pain
• pain during lifting or curling movements
• discomfort during overhead pressing
• tenderness in bicipital groove region
• clicking or discomfort in front of shoulder

The test may become more meaningful when combined with:

• Yergason’s Test
• O’Brien’s Test
• bicipital groove palpation
• symptom history
• shoulder strength testing

When Not to Use or Be Cautious

Use caution when:

• acute shoulder injury is suspected
• severe pain is present
• recent tendon rupture is suspected
• symptoms are highly irritable

Stop testing if:

• pain becomes excessive
• sharp pain occurs
• guarding increases significantly

Equipment Required

• None required
• Optional resistance provided by examiner

Step-by-Step Protocol

Setup

Client stands or sits upright with arm positioned for testing.

Positioning

1. Shoulder flexed to ~90° (or slightly higher depending on variation)
2. Elbow fully extended
3. Forearm supinated

Resistance Application

1. Apply downward resistance to the arm.
2. Ask client to resist shoulder flexion.
3. Maintain position for a brief controlled contraction.
4. Observe pain location and quality.

Instructions

Ask the client to:

• maintain arm position
• report pain location
• describe symptom quality (sharp, dull, ache, catching)

Positive Finding

A positive Speed’s Test may involve:

• pain in anterior shoulder
• tenderness in bicipital groove
• reproduction of familiar symptoms
• discomfort during resisted flexion

Negative Finding

A negative finding involves:

• no pain reproduction
• good tolerance to resistance

Positive vs Negative Interpretation

Positive Interpretation

A positive test may suggest:

• long head biceps tendon irritation
• anterior shoulder loading sensitivity
• possible tendon involvement

It becomes more meaningful when combined with:

• bicipital groove tenderness
• Yergason’s Test positivity
• anterior shoulder pain history

However, it does not confirm:

• tendon tear
• SLAP lesion
• structural pathology independently

Negative Interpretation

A negative test may reduce suspicion of biceps tendon involvement during resisted flexion, but:

• other structures may still be involved
• symptoms may be position-specific
• further testing may still be needed

Normative Data, Benchmarks or Reference Values

There are no established normative values for Speed’s Test.

Interpretation is based on:

• symptom reproduction (yes/no)
• pain location
• comparison side
• consistency across repeated testing

Practical benchmarks include:

• reduced pain over time
• improved load tolerance
• improved shoulder flexion strength

Reliability and Validity

Research on Speed’s Test shows:

• variable diagnostic accuracy
• improved value when used in clusters
• limited stand-alone reliability

Reliability may be influenced by:

• resistance consistency
• arm positioning
• symptom irritability
• examiner technique

At present:

• strong MDC/SEM values are not well established

Sensitivity and Specificity

Reported sensitivity and specificity vary widely across studies depending on:

• reference standard used
• population tested
• interpretation criteria

Overall consensus:

• Speed’s Test alone is not highly specific
• diagnostic accuracy improves in combination with other tests

Common Errors and Limitations

Common errors:

• inconsistent resistance direction
• allowing elbow flexion compensation
• over-interpreting mild discomfort
• not comparing sides

Limitations:

• overlap with rotator cuff pathology
• variable symptom reproduction
• limited stand-alone diagnostic value

Practical Applications

Speed’s Test may help:

• assess anterior shoulder load tolerance
• support biceps tendon assessment
• guide exercise modification
• monitor symptom changes
• assist in test clustering

Often most useful alongside:

• Yergason’s Test
• O’Brien’s Test
• palpation findings
• ROM assessment
• strength testing

How to Record This in Measurz

Record:

• Test name: Speed’s Test
• Side tested
• Positive / negative / unclear
• Pain location
• Pain score
• Resistance tolerance
• Symptom quality
• Comparison side response
• Related tests performed
• Functional aggravating movements
• Retest date

Related Tests / Internal Links

• Yergason’s Test
• O’Brien’s Test
• Bicipital Groove Palpation
• Empty Can Test
• Load and Shift Test

FAQs

What does Speed’s Test assess?

It assesses long head biceps tendon irritation during resisted shoulder flexion.

Does Speed’s Test diagnose biceps tears?

No. It supports clinical reasoning but does not confirm structural tears.

What is a positive Speed’s Test?

Anterior shoulder pain or bicipital groove tenderness during resisted flexion.

Should it be used alone?

No. It is most useful as part of a cluster of shoulder tests.

Key Takeaways

• Speed’s Test assesses anterior shoulder and biceps tendon load response
• Positive findings suggest irritation, not diagnosis
• Best used with other biceps and shoulder tests
• Reliability improves when combined with clinical reasoning
• Interpretation depends on symptom reproduction and comparison

References

Cook, C., & Hegedus, E. J. (2021). Orthopedic physical examination tests: An evidence-based approach (3rd ed.). Pearson.

Krill, M. K., Borchers, J. R., & Hoffman, J. T. (2018). Physical examination of the shoulder. Sports Health, 10(4), 366–371. https://doi.org/10.1177/1941738118765734

Morrow, E. K., Morris, J. H., & Struyf, F. (2020). Clinical examination and physical assessment of shoulder pain. British Journal of Sports Medicine, 54(20), 1208–1215. https://doi.org/10.1136/bjsports-2019-101168