O'Briens Test: Difference between revisions

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'''Original Editor '''- [[User:Jason Harris, PT, DPT|Jason Harris]]
'''Original Editor ''' - [[User:Jason Harris, PT, DPT|Jason Harris]]  


'''Lead Editors''' - [[User:Tyler Shultz|Tyler Shultz]]
'''Lead Editors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
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== Purpose<br> ==
== Purpose  ==


The purpose of the O'Brien Active Compression test is to indicate potential labral ([[SLAP Lesion|SLAP Lesion]])or acromioclavicular lesions as cause for shoulder pain.<br>
The purpose of O'Brien's Active Compression Test is to indicate potential labral ([[SLAP Lesion|SLAP Lesion]]) or acromioclavicular lesions as cause for shoulder pain.  


== Technique<br>  ==
== Technique<ref>O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610-613.</ref>  ==


With the patient in sitting or standing, the upper extremity to be tested is placed in a positon of 90° of shoulder flexion and 10° of horizontal abduction.&nbsp; The patient then completely internally rotates at the shoulder and pronates at the elbow.&nbsp; The practitioner then provides distal stabilizing force as the patient is instructed to apply upward force.&nbsp; The procedure is then repeated in a shoulder and forearm neutral position.&nbsp; A positive test occurs with pain reproduction or clicking in the shoulder with the first position and reduced/absent with the second position.&nbsp; Depth of symptoms must also be assessed as superfiscial pain likely indicates acromioclavicular joint symptoms and deep pain is more likely labral symptoms.<ref>O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610-613.</ref><br>
*With the patient in sitting or standing, the upper extremity to be tested is placed in 90° of shoulder flexion and 10-15° of horizontal adduction
*The patient then fully internally rotates the shoulder and pronates the elbow  
*The examiner provides a distal stabilizing force as the patient is instructed to apply an upward force  
*The procedure is then repeated in a neutral shoulder and forearm position  
*A positive test occurs with pain reproduction or clicking in the shoulder with the first position and reduced/absent with the second position  
*Depth of symptoms must also be assessed as superficial pain can indicate acromioclavicular joint symptoms and deep pain is more often a sign of a labral lesion


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<ref>Online Video, http://esorproductions.pbwiki.com/, Last Accessed 11/07/08</ref><br>
 
== Resources  ==
 
add any relevant resources here


== Evidence  ==
== Evidence  ==


The Sensitivity and Specificity of the Acitve Compression Test of O'Brien have been reported to vary widely and it has been reported that no one test that can accurately diagnose SLAP Lesions<ref>Parentis, Michael Andrew et al. “An evaluation of the provocative tests for superior labral anterior posterior lesions.” The American Journal of Sports Medicine 34.2 (2006): 265-8.</ref>.&nbsp; Studies have shown O'Brien's test to have a Specificity that ranges from 28% - 73% and a Sensitivity of 63% - 94% <ref>Ebinger, Nina et al. “A new SLAP test: the supine flexion resistance test.” Arthroscopy: The Journal of Arthroscopic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 24.5 (2008): 500-5.</ref><ref>Guanche, Carlos A, and Donald C Jones. “Clinical testing for tears of the glenoid labrum.” Arthroscopy: The Journal of Arthroscopic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 19.5: 517-23.</ref> .&nbsp; <br>  
The sensitivity and specificity of the O'Brien's Active Compression Test have been reported to vary widely and no one test can accurately diagnose a SLAP Lesion.<ref>Parentis, Michael Andrew et al. “An evaluation of the provocative tests for superior labral anterior posterior lesions.” The American Journal of Sports Medicine 34.2 (2006): 265-8.</ref> Studies have shown O'Brien's Test to have a specificity ranging from 28-73% and a sensitivity of 63-94%.<ref>Ebinger, Nina et al. “A new SLAP test: the supine flexion resistance test.” Arthroscopy: The Journal of Arthroscopic Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 24.5 (2008): 500-5.</ref><ref>Guanche, Carlos A, and Donald C Jones. “Clinical testing for tears of the glenoid labrum.” Arthroscopy: The Journal of Arthroscopic Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 19.5: 517-23.</ref>  


However, when grouped with other tests for SLAP lesions such as the [[Crank Test|Crank]], [[Apprehension Test|Anterior Apprehension]] and one of either Biceps Load II, [[Speeds Test|Speed's]], or [[Yergasons Test|Yergerson's]] the overall Sensitivity to be 75% and Specificity to be 90%<ref>Oh, Joo Han et al. “The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion.” The American journal of sports medicine 36.2 (2008): 353-9.</ref>. <br> <br>  
However, when grouped with other tests for SLAP lesions such as the [[Crank Test|Crank]], [[Apprehension Test|Anterior Apprehension]] and one of either Biceps Load II, [[Speeds Test|Speed's]], or [[Yergasons Test|Yergerson's]], the overall sensitivity was found to be 75% and 90% specific.<ref>Oh, Joo Han et al. “The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion.” The American journal of sports medicine 36.2 (2008): 353-9.</ref>  


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|+ Diagnostic Accuracy for Acromioclavicular Lesions <ref>Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion</ref>  
|+ Diagnostic Accuracy for Acromioclavicular Lesions<ref>Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion</ref>  
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|+ Diagnostic Accuracy for Labral Tears <ref>Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion</ref>  
|+ Diagnostic Accuracy for Labral Tears<ref>Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion</ref>  
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<br> See [[Test Diagnostics|test diagnostics]] page for explanation of statistics.
<br>  


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See [[Test Diagnostics|test diagnostics]] for a more in-depth explanation of these statistics.
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==


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== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
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<references />
[[Category:Assessment]]
[[Category:Articles]] [[Category:Special_Tests]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Shoulder]] [[Category:Videos]]
[[Category:Special_Tests]]
[[Category:Shoulder - Special Tests]]
[[Category:Shoulder - Assessment and Examination]]  
[[Category:Shoulder]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category:CPA_Ortho_Div_Resources]]
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]

Latest revision as of 16:16, 29 August 2019

Original Editor - Jason Harris

Lead Editors - Jason Harris, PT, DPT, Rachael Lowe, Evan Thomas, Admin, Tyler Shultz, Scott Buxton, WikiSysop, Kim Jackson, Wanda van Niekerk, Tony Lowe, Eric Robertson, Tim Noteboom, Wendy Walker, Naomi O'Reilly and Kai A. Sigel

Purpose[edit | edit source]

The purpose of O'Brien's Active Compression Test is to indicate potential labral (SLAP Lesion) or acromioclavicular lesions as cause for shoulder pain.

Technique[1][edit | edit source]

  • With the patient in sitting or standing, the upper extremity to be tested is placed in 90° of shoulder flexion and 10-15° of horizontal adduction
  • The patient then fully internally rotates the shoulder and pronates the elbow
  • The examiner provides a distal stabilizing force as the patient is instructed to apply an upward force
  • The procedure is then repeated in a neutral shoulder and forearm position
  • A positive test occurs with pain reproduction or clicking in the shoulder with the first position and reduced/absent with the second position
  • Depth of symptoms must also be assessed as superficial pain can indicate acromioclavicular joint symptoms and deep pain is more often a sign of a labral lesion

Evidence[edit | edit source]

The sensitivity and specificity of the O'Brien's Active Compression Test have been reported to vary widely and no one test can accurately diagnose a SLAP Lesion.[2] Studies have shown O'Brien's Test to have a specificity ranging from 28-73% and a sensitivity of 63-94%.[3][4]

However, when grouped with other tests for SLAP lesions such as the Crank, Anterior Apprehension and one of either Biceps Load II, Speed's, or Yergerson's, the overall sensitivity was found to be 75% and 90% specific.[5]

Diagnostic Accuracy for Acromioclavicular Lesions[6]
Sensitivity  0.41 - 1.00
Specificity  0.95 - 0.97
Positive Likelihood Ratio  8.2 - 33.3
Negative Likelihood Ratio  0.00 - 0.62


Diagnostic Accuracy for Labral Tears[7]
Sensitivity  0.63 - 1.00
Specificity  0.73 - 0.98
Positive Likelihood Ratio  2.30 - 50.0
Negative Likelihood Ratio  0.00 - 0.51


See test diagnostics for a more in-depth explanation of these statistics.

References[edit | edit source]

  1. ↑ O'Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610-613.
  2. ↑ Parentis, Michael Andrew et al. “An evaluation of the provocative tests for superior labral anterior posterior lesions.” The American Journal of Sports Medicine 34.2 (2006): 265-8.
  3. ↑ Ebinger, Nina et al. “A new SLAP test: the supine flexion resistance test.” Arthroscopy: The Journal of Arthroscopic Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 24.5 (2008): 500-5.
  4. ↑ Guanche, Carlos A, and Donald C Jones. “Clinical testing for tears of the glenoid labrum.” Arthroscopy: The Journal of Arthroscopic Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 19.5: 517-23.
  5. ↑ Oh, Joo Han et al. “The evaluation of various physical examinations for the diagnosis of type II superior labrum anterior and posterior lesion.” The American journal of sports medicine 36.2 (2008): 353-9.
  6. ↑ Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
  7. ↑ Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
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