Reinterpretation of O'Brien test in posterior labral tears of the shoulder

Authors: J M Owen, T Boulter, M Walton, T A Mackenzie, L Funk

References: International Journal of Shoulder Surgery, 2015

Injuries to the posterior labrum are less common and more difficult to diagnose compared to anterior labral pathology. This may be in part due to difficulties in preoperative diagnosis. Posterior labral injuries cause abnormal loading of the rotator cuff with subsequent weakness. Examination using the Modified O’Briens test tightens the posterior capsule and posteriorly translates the humeral head, stressing the labrum resulting in pain and weakness. A retrospective case controlled study of 74 patients diagnosed with a posterior labral tear at arthroscopy showed 55 to have subjective weakness on performing a Modified O’Briens test, a sensitivity of 83% and a positive predictive value of 90%. At present there is no single test diagnostic of  posterior labral pathology. They can often be missed on MRI scanning and also at surgery if not specifically looked for. We believe that clinically demonstrated weakness on performing a Modified O’Briens test is sensitive, with a high positive predictive value for posterior labral pathology and can help guide further treatment.

Description of Modified O'Briens Test / WPITT:

  • The test is conducted in a similar manner to that initially described by O’Brien. 
  • The patient is asked to forward flex the affected arm 90° with the elbow in full extension. 
  • The patient then adducts the arm medial to the sagittal plane of the body. 
  • The arm is internally rotated so that the thumb points downward. 
  • The examiner applies a moderate downward force to the arm being resisted by the patient. 
  • The test is considered positive with weakness observed by the examiner when a moderate downward force on the arm results in loss of forward flexion from 90°.


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