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Special tests for the acromioclavicular joint (ACJ). The Obrien's Active Compression Test, Cross-body (passive adduction) Test, Resisted Extension Test, and palpation (screening tool). The reliability, specificity, sensitivity, validity, safety, and screening for shoulder pain, ACJ pathology/injury, impingement, rotator cuff tears, SLAP tears, lesions, and labrum (labral) tears.

Special Tests: Acromioclavicular (AC) Joint Pathology

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Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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Acromioclavicular (AC) Joint Test-item Cluster

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.

 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).

Two or more positive tests on the AC Joint Test-item Cluster only slightly increase likelihood ratios when compared to the 

 alone (25). This implies that adding the 

 is likely sufficient, as the addition of a 3rd test (e.g. 

 may not result in any additional increase in predictive value.

 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 

 to this cluster. Positive results for the 

, 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

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:

Courses covering Special Tests for the Shoulder Girdle

Special Tests: Shoulder Impingement Syndrome (SIS)

Special Tests: Shoulder Instability (Apprehension) and Labrum Pathology

Course Description: Special Tests: Acromioclavicular (AC) Joint Pathology

Introduction

For an introduction to Special Tests including definitions of specific terminology, what special tests measure, how we chose the tests in these lessons, and best use, check out:

O'Brien's Active Compression Test

The patient is standing with the involved shoulder flexed to 90° and internally rotated to end-range in the scapular plane, with the elbow extended.

The examiner stands on the side of the involved shoulder and asks the patient to resist a downward force applied to the wrist.

The patient is asked to report any pain and the location of that pain. Top of the shoulder may indicate acromioclavicular (AC) joint pathology, and inside of the shoulder may indicate a superior labrum tear, anterior to posterior (SLAP lesion).

The practitioner then moves the patient's arm into end-range shoulder external rotation and asks the patient to again resist a downward force to the wrist.

A positive test is pain or painful clicking in the internally rotated position, and less or no pain in the externally rotated position.

Weakness may be indicative of posterior labral tear (23), pain on palpation of the bicipital tunnel during the test may be indicative of damage to the biceps tendon/labrum complex, or transverse ligament (24), pain in or on the AC joint in the thumbs down position may be indicative of AC joint pathology (7, 14, 22)

Image of the AC Joint

Cross Body (Horizontal Adduction Test)

The patient is sitting with involved shoulder flexed to 90°, neutral rotation, and elbow flexed to 90°

The examiner stands on the side of the involved shoulder with one hand stabilizing the scapula and torso (fingers over top of scapula, palm on the body of the scapula), and the other hand in a lumbrical grip around the elbow of the involved side.

The examiner then passively horizontally adducts the shoulder to end range and applies mild over-pressure.

The test is positive if shoulder pain is present.

Image of the Rotator Cuff

Resisted Extension Test

The patient is sitting with the involved shoulder flexed to 90°, neutral rotation, and elbow flexed 90°.

The examiner then asks the patient to horizontally abduct the arm while the examiner provides isometric resistance to movement.

Acromioclavicular (AC) Joint Test-item Cluster (and Screening)

AC Joint Resist Test

Cook, C., & Hegedus, E. J. (2008). Orthopedic physical examination tests: an evidence-based approach.

Dutton's Orthopaedic examination, evaluation, and intervention

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. 

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. 

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. 

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. 

Guanche, C. A., & Jones, D. C. (2003). Clinical testing for tears of the glenoid labrum. 

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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. 

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)

McFarland, E. G., Kim, T. K., & Savino, R. M. (2002). Clinical assessment of three common tests for superior labral anterior-posterior lesions. 

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. 

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. 

Walton, J., Mahajan, S., Paxinos, A., Marshall, J., Bryant, C., Shnier, R., … & Murrell, G. A. (2004). Diagnostic values of tests for acromioclavicular joint pain. 

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. 

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. 

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. 

Ebinger, N., Magosch, P., Lichtenberg, S., & Habermeyer, P. (2008). A new SLAP test: the supine flexion resistance test. 

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. 

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. 

Powell, J. W., & Huijbregts, P. A. (2006). Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. 

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. 

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

Cross-body (Horizontal Adduction) Test (17)

Chronopoulos, E., Kim, T. K., Park, H. B., Ashenbrenner, D., & McFarland, E. G. (2004). Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. 

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. 

Mclaughlin, H. L. (1961). The “frozen shoulder”. 

Clinical Orthopaedics and Related Research®

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. 

Çalış, M., Akgün, K., Birtane, M., Karacan, I., Çalış, H., & Tüzün, F. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. 

Jacob, A. K., & Sallay, P. I. (1997). Therapeutic efficacy of corticosteroid injections in the acromioclavicular joint. 

Goyal, P., Hemal, U., & Kumar, R. (2010). High resolution sonographic evaluation of painful shoulder. 

Bibliography

Questions, comments, and criticisms are welcomed and encouraged