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O'Briens Test

From Physiopedia

Original Editor - Jason Harris

Lead Editors - Tyler Shultz

Contents

Purpose

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

Technique

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 adduction.  The patient then completely internally rotates at the shoulder and pronates at the elbow.  The practitioner then provides distal stabilizing force as the patient is instructed to apply upward force.  The procedure is then repeated in a shoulder and forearm neutral 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 labral symptoms.[1]

[2]

Resources

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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[3].  Studies have shown O'Brien's test to have a Specificity that ranges 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 to be 75% and Specificity to be 90%[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 page for explanation of statistics.

Recent Related Research (from Pubmed)

References

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  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. Online Video, http://esorproductions.pbwiki.com/, Last Accessed 11/07/08
  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

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