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Clinical Tests for Shoulder

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Clinical Tests for Shoulder
Shoulder Examination TestsShoulder Examination Tests
Anterior Apprehension TestAnterior Apprehension Test
Anterior Drawer TestAnterior Drawer Test
Biceps Load TestBiceps Load Test
Biceps Load Test 2Biceps Load Test 2
Empty Can/Full Can TestEmpty Can/Full Can Test
Hawkins-Kennedy TestHawkins-Kennedy Test
Inferior Sulcus TestInferior Sulcus Test
Jobe Relocation TestJobe Relocation Test
Lift-Off TestLift-Off Test
Load & Shift TestLoad & Shift Test
Neer Impingement SignNeer Impingement Sign
OBriens TestOBriens Test
Pain Provocation TestPain Provocation Test
Posterior Drawer TestPosterior Drawer Test
SLAPprehension TestSLAPprehension Test
Speeds TestSpeeds Test
Yergasons TestYergasons Test
The Shoulder Symptom Modification Procedure (SSMP)The Shoulder Symptom Modification Procedure (SSMP)



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OBriens Test

O'Brien's active compression test was primarily developed for assessment of Acromioclavicular joint pathology following a patient's demonstration of what reproduced their shoulder pain. O'Brien noted in a series of patients it was also excellent for detecting labral pathology.

Test

The patient is instructed to flex their arm to 90° with the elbow fully extended and then adduct the arm 10-15°medial to sagittal plane. The arm is then maximally internally rotated and the patient resists the examiner's downward force. The procedure is repeated in supination. The O'Brien Test is designed to maximally load and compress the ACJ and superior labrum. For maximal results the authors stress that the patient should resist the examiner's downward force rather than the examiner resisting forward flexion.

Positive

Pain elicited by the fIrst manoeuvre is reduced or eliminated by second.

ACJ pain =ACJ
Pain or clicking deep in the GHJ = labral

Arthroscopy revealed that the test position (90° forward flexion, 10-15° adduction and maximum internal rotation) displaces the biceps tendon medially and inferiorly therefore putting tension on the bicipitallabral complex. A secondary shear is created in the glenoid and labrum. In an unstable SLAP lesion tension from the biceps tendon from this shear, compression from capsular windup, or both creates an internal mechanical derangement and displacement that accounts for the painful clicking that patients experience. For a positive test the patient MUST report a significant decrease in symptomology in the supination test position. Cadaver studies (Parentis et al 2004) have clarified contact between the lesser tuberosity, subscapularis tendon and superior aspect of the glenoid and labrum in the internally rotated position.

Cadaver studies examined the anatomical basis of the ACJ component of the test. They revealed that the highest compressive pressure was generated in the test position. The greater tuberosity elevates the relatively depressed acromion and locks and loads the ACJ. Full supination relaxed the joint by virtue of the greater tuberosity moving out of the way.

The following results are based on O'Brien's prospective study of 268 patients.

   Sensitivity   Specificity    NPV
labral   100%   98.5%   100%
ACJ    100%    96.6%    100%

Research

Compared to:

   Sensitivity    Specificity    NPV
Stetson (2002)    54%    31%    50%!
Guanche (2003) (For labral)   63%    73%
Chronopoulos E(2004) (For ACJ)    41%    95%    >94%
a structure (tissue) that attaches a muscle to a bone. When a tendon becomes inflamed, the condition is referred to as tendinitis or tendonitis.
at the top; towards the head
The most anterior muscle and tendon of the rotator cuff. Internally rotates the shoulder.
Superior Labral Antero-Posterior lesion - Abbreviated term for an injury to the superior labrum of the glenoid.
towards the centre of the body; inwards
A firm, white structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint). It deepens the socket, providing stability to the joint.
The labrum is a firm, white structure that forms a ring around the glenoid cavity (the cup of the ball and socket shoulder joint). It deepens the socket, providing stability to the joint.
at the botom; towards the feet
moving of a body part toward the central axis of the body
Acromio-clavicular Joint - the small joint at the top of your shoulder. A firm lump that you can feel.


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