O'Briens Test

Contents

Purpose

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]

  • 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 more often a sign of a labral lesion

[2]

Evidence

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.[3] Studies have shown O'Brien's Test to have a specificity ranging from 28-73% and a sensitivity of 63-94%.[4][5]

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.[6]

Diagnostic Accuracy for Acromioclavicular Lesions[7]
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[8]
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.

Recent Related Research (from Pubmed)

References

  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. EverydayPT. Accessed June 22, 2016 from https://www.youtube.com/watch?v=v_EL9XqTJQQ
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  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
  8. 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