Special Tests: Acromioclavicular (AC) Joint Pathology

Special Tests Covered in this Lesson:

• Acromioclavicular (AC) Joint Test-item Cluster
  • Obrien's Active Compression Test
  • Cross-body (Passive Adduction) Test
  • Resisted Extension Test
• Screening Tool
  • Palpation (High Sensitivity)

Acromioclavicular joint (AC joint) pain may result from repetitive use injury or trauma. Repetitive use injuries may include AC joint arthritis or AC ligament inflammation, and relatively minor injuries may include AC joint strain and sprain (e.g. coracoclavicular ligament strain). More serious trauma can result in AC joint separation in which the distal clavicle (collar bone) separates from the acromion process of the scapula (shoulder blade). For an accurate diagnosis, AC joint pain must be differentiated from shoulder impingement syndrome, shoulder arthritis, and rotator cuff pathology (e.g. rotoator cuff tear). Clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of the signs and symptoms of AC joint dysfunction and the special tests that may aid in diagnosing and screening patients and clients. Most often AC joint dysfunction can be treated with exercise and interventions intended to improve lower cervical and thoracic mobility, scapular (shoulder blade) stabilizer activity, and reinforcement from a home exercise program.

Special Notes on AC Joint Special Tests:

• Simple Screen: Pain during palpation of the AC joint may be an effective screen. A study by McFarland et al. showed that AC joint palpation had 96% sensitivity (better than any other test), but 10% specificity. This implies that a negative test likely rules out AC joint dysfunction; however, a positive test can only imply a need for further testing (11).
• Identifying AC Joint Dysfunction: Two or more positive tests on the AC Joint Test-item Cluster only slightly increase likelihood ratios when compared to the Resisted Extension Test alone (25). This implies that adding the Resisted Extension Test to Obrien's Active Compression Test is likely sufficient, as the addition of a 3rd test (e.g. Cross-body (Passive Adduction) Test may not result in any additional increase in predictive value.

Brookbush Institute Recommendation

The Obrien's Active Compression Test is included in the Brookbush Institute's "Best of" Instability and Labral Pathology cluster, it is recommended that pain on the top of the shoulder during the Obrien's test results in the addition of the Resisted Extension Test to this cluster. Positive results for the Obrien's and Resisted Extension Test , in conjunction with negative results for the other tests in the cluster, would strongly imply that pain is the result of AC joint dysfunction.

Brookbush Institute's "Best of" Instability, Labral Pathology, and AC Joint Cluster

• Apprehension Test
• Jobe's Relocation Test
• Biceps Load 2
• Jerk Test
• Obrien's Active Compression Test
• Resisted Extension Test

For an Introduction to Special Tests:

• For an introduction to Special Tests including definitions of specific terminology, what special tests measure, accuracy (specificity, sensitivity, reliability, etc.), how we chose the tests in each special test course lessons, and best practice recommendations:
• Special Tests: Introduction

Courses covering Special Tests for the Shoulder Girdle

• Special Tests: Shoulder Impingement Syndrome (SIS)
• Special Tests: Rotator Cuff Pathology
• Special Tests: Acromioclavicular (AC) Joint Pathology
• Special Tests: Shoulder Instability (Apprehension) and Labrum Pathology

Pre-approved credits for:

• Integrated Manual Therapist (IMT) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Physical Therapists
• Physical Therapy Assistants

This Course Includes:

• AI Tutor
• Text and Illustrations
• Audio Voice-over
• Technique Videos
• Practice Exam
• Pre-approved Final Exam

1. Cook, C., & Hegedus, E. J. (2008). Orthopedic physical examination tests: an evidence-based approach.
2. Dutton, M. (2012). Dutton's Orthopaedic examination, evaluation, and intervention. McGraw-Hill Medical.
3. Magee, D. J. (2013). Orthopedic physical assessment. Elsevier Health Sciences.
4. Hegedus, E. J., Goode, A., Campbell, S., Morin, A., Tamaddoni, M., Moorman, C. T., & Cook, C. (2008). Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. British journal of sports medicine, 42(2), 80-92.
5. Hegedus, E. J., Goode, A. P., Cook, C. E., Michener, L., Myer, C. A., Myer, D. M., & Wright, A. A. (2012). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med, 46(14), 964-978.
   • O'Brien's Active Compression Test
6. Oh, J. H., Kim, J. Y., Kim, W. S., Gong, H. S., & Lee, J. H. (2008). 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), 353-359.
7. O'Brien, S. J., Pagnani, M. J., Fealy, S., McGlynn, S. R., & Wilson, J. B. (1998). The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. The American journal of sports medicine, 26(5), 610-613.
8. Guanche, C. A., & Jones, D. C. (2003). Clinical testing for tears of the glenoid labrum. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 19(5), 517-523.
9. Morgan, C. D., Burkhart, S. S., Palmeri, M., & Gillespie, M. (1998). Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 14(6), 553-565.
10. Parentis, M. A., Mohr, K. J., & ElAttrache, N. S. (2002). Disorders of the superior labrum: review and treatment guidelines. Clinical Orthopaedics and Related Research (1976-2007), 400, 77-87.
11. McFarland, E. G., Kim, T. K., & Savino, R. M. (2002). Clinical assessment of three common tests for superior labral anterior-posterior lesions. The American journal of sports medicine, 30(6), 810-815.
12. Stetson, W. B., & Templin, K. (2002). The crank test, the O'Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. The American journal of sports medicine, 30(6), 806-809.
13. Myers, T. H., Zemanovic, J. R., & Andrews, J. R. (2005). The resisted supination external rotation test: a new test for the diagnosis of superior labral anterior posterior lesions. The American journal of sports medicine, 33(9), 1315-1320.
14. Walton, J., Mahajan, S., Paxinos, A., Marshall, J., Bryant, C., Shnier, R., … & Murrell, G. A. (2004). Diagnostic values of tests for acromioclavicular joint pain. JBJS, 86(4), 807-812.
15. Nakagawa, S., Yoneda, M., Hayashida, K., Obata, M., Fukushima, S., & Miyazaki, Y. (2005). Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 21(11), 1290-1295.
16. Parentis, M. A., Glousman, R. E., Mohr, K. S., & Yocum, L. A. (2006). An evaluation of the provocative tests for superior labral anterior posterior lesions. The American journal of sports medicine, 34(2), 265-268.
17. Jia, X., Petersen, S. A., Khosravi, A. H., Almareddi, V., Pannirselvam, V., & McFarland, E. G. (2009). Examination of the shoulder: the past, the present, and the future. JBJS, 91(Supplement_6), 10-18.
18. Ebinger, N., Magosch, P., Lichtenberg, S., & Habermeyer, P. (2008). A new SLAP test: the supine flexion resistance test. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 24(5), 500-505.
19. Ben Kibler, W., Sciascia, A. D., Hester, P., Dome, D., & Jacobs, C. (2009). Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. The American journal of sports medicine, 37(9), 1840-1847.
20. Oh, J. H., Kim, J. Y., Kim, W. S., Gong, H. S., & Lee, J. H. (2008). 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), 353-359.
21. Walsworth, M. K., Doukas, W. C., Murphy, K. P., Mielcarek, B. J., & Michener, L. A. (2008). Reliability and diagnostic accuracy of history and physical examination for diagnosing glenoid labral tears. The American journal of sports medicine, 36(1), 162-168.
22. Powell, J. W., & Huijbregts, P. A. (2006). Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. Journal of Manual & Manipulative Therapy, 14(2), 19E-29E.
23. Taylor, S. A., Newman, A. M., Dawson, C., Gallagher, K. A., Bowers, A., Nguyen, J., … & O'Brien, S. J. (2017). The “3-pack” examination is critical for comprehensive evaluation of the biceps-labrum complex and the bicipital tunnel: a prospective study. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 33(1), 28-38.
24. Owen, J. M., Boulter, T., Walton, M., Funk, L., & Mackenzie, T. A. (2015). Reinterpretation of O'Brien test in posterior labral tears of the shoulder. International journal of shoulder surgery, 9(1), 6.
    • Cross-body (Horizontal Adduction) Test (17)
25. Chronopoulos, E., Kim, T. K., Park, H. B., Ashenbrenner, D., & McFarland, E. G. (2004). Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. The American journal of sports medicine, 32(3), 655-661.
26. Ostor, A. J. K., Richards, C. A., Prevost, A. T., Hazleman, B. L., & Speed, C. A. (2004). Interrater reproducibility of clinical tests for rotator cuff lesions. Annals of the rheumatic diseases, 63(10), 1288-1292.
27. Mclaughlin, H. L. (1961). The “frozen shoulder”. Clinical Orthopaedics and Related Research®, 20, 126-131.
28. Park, H. B., Yokota, A., Gill, H. S., El Rassi, G., & McFarland, E. G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. JBJS, 87(7), 1446-1455.
29. Çalış, M., Akgün, K., Birtane, M., Karacan, I., Çalış, H., & Tüzün, F. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the rheumatic diseases, 59(1), 44-47.
    • Resisted Extension Test (17, 25)
30. Jacob, A. K., & Sallay, P. I. (1997). Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint. Biomedical sciences instrumentation, 34, 380-385.
31. Goyal, P., Hemal, U., & Kumar, R. (2010). High resolution sonographic evaluation of painful shoulder. Internet Journal of Radiology, 12, 22.
    • Cluster and Palpation (14, 25)