The Biceps Load II Test assesses whether resisted elbow flexion in an abducted and externally rotated shoulder position reproduces or increases shoulder pain that may be associated with the superior labrum and biceps anchor. A positive test may increase suspicion of SLAP or biceps-labral complex involvement when it reproduces familiar deep shoulder pain. Current expert consensus on SLAP and biceps anchor disorders emphasises that diagnosis should use history, examination, imaging and clinical context rather than one test alone.
A throwing athlete reports deep shoulder pain in the cocking phase. A gym client reports painful clicking during overhead pressing or pulling. Another client reports symptoms near the top of the shoulder that worsen with resisted elbow flexion in an overhead position.
The Biceps Load II Test can help assess whether loading the biceps-labral complex reproduces familiar symptoms. It should not be used as a stand-alone diagnostic test for a SLAP lesion.
Test name: Biceps Load II Test
Body region: Shoulder, biceps anchor, superior labrum
Purpose: Assess symptom response to resisted elbow flexion in a shoulder-abducted and externally rotated position
Positive finding: Pain is reproduced or increased during resisted elbow flexion
Negative finding: Pain is unchanged, reduced or not reproduced during resisted elbow flexion
Best used with: O’Brien’s Test, Crank Test, Passive Compression Test, biceps tests, shoulder ROM, instability tests and history
Key limitation: It does not diagnose a SLAP lesion on its own
The Biceps Load II Test is a shoulder special test designed to load the long head of biceps and superior labrum. It is commonly performed with the client supine, the shoulder abducted to approximately 120 degrees and externally rotated, the elbow flexed to 90 degrees and the forearm supinated. The client then resists elbow flexion.
The main outcome is whether resisted elbow flexion reproduces or increases the client’s familiar shoulder pain.
The test is used when superior labral or biceps anchor involvement is part of the clinical reasoning.
It may help assess clients with deep shoulder pain, painful clicking, throwing-related symptoms, overhead sport pain, traction-type shoulder symptoms or pain in positions of abduction and external rotation.
The test assesses symptom response when the biceps contracts in a position that may stress the superior labrum and biceps anchor.
It does not directly visualise the labrum and does not confirm a SLAP tear.
This test may be useful for throwers, swimmers, racquet sport athletes, gym clients, overhead workers and clients with deep shoulder pain, clicking or suspected biceps-labral complex symptoms.
Use when the client can tolerate shoulder abduction and external rotation and the clinical question involves the superior labrum or biceps anchor.
Use caution with acute shoulder instability, recent dislocation, severe apprehension, suspected fracture, recent surgery, high pain irritability, acute biceps injury or inability to tolerate the test position.
Treatment table
Pain and symptom scale
Measurz recording workflow
Optional comparison side notes
Position the client supine.
Abduct the shoulder to approximately 120 degrees, externally rotate the shoulder, flex the elbow to 90 degrees and place the forearm in supination.
Stand beside the tested shoulder.
Support the wrist or distal forearm and stabilise the shoulder as needed.
Avoid excessive anterior shoulder translation or uncontrolled shoulder movement.
Ask the client to flex the elbow while you apply resistance.
Ask the client to report pain, clicking, deep shoulder symptoms, apprehension and whether symptoms are familiar.
A positive test is reproduction or increase of familiar shoulder pain during resisted elbow flexion.
A negative test is no pain, unchanged pain or reduced pain during resisted elbow flexion.
Stop if pain increases sharply, apprehension occurs, instability symptoms appear or the test position is not tolerated.
Do not force abduction/external rotation. Record whether symptoms are deep, anterior, superior, clicking-related or instability-related.
A positive Biceps Load II Test may increase suspicion of biceps-labral complex or superior labral involvement when it reproduces familiar deep shoulder pain in a relevant history.
A negative test does not rule out SLAP pathology. SLAP presentations are variable and often overlap with rotator cuff, instability, biceps tendon and posterior shoulder symptoms.
Interpretation is stronger when combined with history, overhead workload, O’Brien’s Test, Crank Test, Passive Compression Test, shoulder ROM, biceps testing, instability testing and imaging where clinically relevant.
The original Biceps Load II study reported high diagnostic values:
Sensitivity: approximately 89.7%
Specificity: approximately 96.9%
Accuracy: approximately 92.1%
However, later systematic review evidence was more cautious. Gismervik et al. (2017) noted that the original Biceps Load II study reported high sensitivity and specificity, but it was excluded from their meta-analysis because of outlier characteristics and potential spectrum bias. They also concluded that single shoulder physical examination tests generally show limited clinical performance.
A 2025 clinical examination techniques paper describes multiple SLAP examination tests and reinforces that a well-performed clinical examination may help detect SLAP lesions, but diagnosis should not rely on a single test.
Reliability depends on consistent shoulder abduction angle, external rotation, elbow angle, resistance direction, symptom criteria and comparison with the other side.
Common errors include poor shoulder angle, not placing the forearm in supination, resisting too aggressively, failing to ask whether symptoms are familiar, interpreting any shoulder pain as SLAP-specific and using the test alone.
Limitations include overlap with biceps tendinopathy, instability, rotator cuff symptoms, apprehension, posterior shoulder pain and limited current standalone diagnostic accuracy evidence.
Use Biceps Load II to document symptom response to biceps loading in an abducted and externally rotated shoulder position. It is most useful in overhead and throwing-related shoulder assessments.
Record test name, side tested, result, pain score, symptom location, symptom quality, shoulder angle, external rotation position, elbow angle, resistance direction, clicking, apprehension, familiar symptoms, comparison side, confidence in result and reason for stopping.
Add related findings such as O’Brien’s, Crank, Passive Compression, biceps strength, shoulder ROM, instability tests, throwing symptoms and overhead workload.
O’Brien’s Test
Crank Test
Passive Compression Test
Biceps Load I Test
Speed’s Test
Apprehension Test
Jobe’s Relocation Test
Shoulder ROM Tests
It assesses whether resisted elbow flexion in an abducted and externally rotated shoulder position reproduces shoulder symptoms linked to the biceps-labral complex.
A positive result is reproduction or increase of familiar shoulder pain during resisted elbow flexion.
No. It may support clinical reasoning but does not diagnose a SLAP lesion on its own.
That is usually considered a negative response for this test, but the symptom change should still be recorded.
Record side, shoulder position, elbow angle, pain response, clicking, apprehension and comparison side.
Biceps Load II loads the biceps-labral complex.
A positive result is increased familiar pain during resisted elbow flexion.
It should not be used alone to diagnose SLAP lesions.
Positioning must be consistent.
Measurz should capture shoulder angle, symptoms and resistance response.
American Shoulder and Elbow Surgeons SLAP/Biceps Anchor Study Group. (2023). Evidence-based and consensus statement on pathoanatomy and diagnosis of clinically relevant superior labrum and biceps anchor disorders. Journal of Shoulder and Elbow Surgery.
Kim, S. H., Ha, K. I., Ahn, J. H., Kim, S. H., & Choi, H. J. (2001). Biceps load test II: A clinical test for SLAP lesions of the shoulder. Arthroscopy, 17(2), 160–164. https://doi.org/10.1053/jars.2001.20665
Gismervik, S. Ø., Drogset, J. O., Granviken, F., Rø, M., & Leivseth, G. (2017). Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance. BMC Musculoskeletal Disorders, 18, 41. https://doi.org/10.1186/s12891-017-1400-0
Nuelle, C. W., et al. (2025). Superior labrum anterior posterior clinical exam techniques. Arthroscopy Techniques.
