An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: the ramp test.

The purpose of this technical note is to introduce the ramp test and explain this arthroscopic technique. The ramp test is used to test the integrity of the soft tissue restraint to intra-articular subluxation of the long head of the biceps tendon. Injury to the soft tissue restraint, the hidden lesion, has been proposed as occurring in conjunction with a full-thickness rotator cuff tear. Both cadaveric dissections and arthroscopic patient assessments were conducted to develop the ramp test. In this study, 17 patients also presented with refractory anterior shoulder pain and underwent arthroscopy to further characterize the ramp test. An abnormal examination result showed that the long head of the biceps tendon translated medially and inferiorly across the humeral head. In addition, this subgroup of 17 patients all had an abnormal ramp test but did not have a full-thickness rotator cuff tear. The ramp test is now applied to all arthroscopic procedures by the senior author, and we recommend its use for arthroscopic confirmation of intra-articular subluxation of the long head of the biceps tendon. Thus, we advocate that an abnormal ramp test result indicates pathology and warrants the surgical removal of the long head of the biceps tendon from the glenohumeral joint.