During Speed's test, weakness in resisted downward force is most consistent with which condition?

• A. Proximal biceps tendon tear
• B. Proximal biceps tendinopathy
• C. SLAP lesion
• D. AC joint arthritis

Answer: (A)

Speed's test stresses the long head of the biceps at its origin. When the proximal biceps tendon is torn, the tendon can no longer transmit the muscle’s force to the forearm. As a result, resisting a downward push during the test reveals true weakness because the tendon–muscle unit cannot generate normal force. Pain may accompany this, but the key clue is the loss of strength from a proximal tendon rupture rather than just inflammation.

If the issue were a biceps tendinopathy without a tear, strength is typically preserved (+ pain). A SLAP lesion can cause pain with provocative maneuvers involving the biceps but does not usually produce the specific weakness on this test. AC joint arthritis would present with pain localized to the AC joint and different provocative patterns, not weakness specifically on Speed’s test.