0:04 This is Brent of the Brookbush 0:05 Institute, in this video we're going over 0:07 the special or orthopedic test the 0:09 O'Briens test also known as the active 0:11 compression test; which can be used to 0:14 help indicate a SLAP lesion, which is a 0:16 superior labral tear from anterior to 0:18 posterior. There's some research to also 0:21 show that it might be indicative of AC 0:23 joint pathology, that's acromioclavicular 0:24 joint pathology. I'm going to have my 0:27 friend Melissa come ou,t she's going to 0:28 help me demonstrate. Now the test itself 0:32 is not difficult, it is a two-part test 0:35 though. so I'm going to have Melissa go 0:37 ahead and bring her arm up to 90 degrees 0:39 of flexion, she's going to go ahead and 0:40 pronate and internally rotate for me, and 0:43 then horizontally adduct her arm 10 to 15 0:46 degrees. I'm then going to apply a 0:49 downward pressure, and I'm going to ask 0:52 her is that the symptoms you were 0:54 complaining about? Alright so that's pain. 0:56 So she has pain in this position but 1:00 when I have her supinate and kind of 1:04 come back to neutral here in 90 degrees 1:07 of flexion, and I pushed down, how does 1:09 that feel?(Okay), that's fine, or even just 1:12 less pain but that's a positive 1:16 O'Brien's test. Alright so positive 1:19 O'Brien's test would be when thumbs-down, 1:22 internally rotated and adducted, I press 1:25 down that's painful, 1:30 this is less painful or not painful at 1:33 all. Alright, you guys got that. Now where do we go 1:38 from here. Well we have to make sure that 1:43 we're actually testing for a SLAP tear 1:46 and not that AC joint pathology I 1:48 mentioned before. So when we were in this 1:52 position just to add one more layer, alright 1:55 making our diagnosis a little bit more 1:57 specific. When I push down I would not 2:02 only ask if she felt pain, does that 2:04 replicate her symptoms, but I would also 2:06 ask where do you feel that? (Inside my 2:09 shoulder). Inside her shoulder, if it's inside 2:12 her shoulder chances are we're looking 2:15 at more of a SLAP lesion pathology right, 2:20 even if she felt it down the front of 2:21 her shoulder in that bicep tendon area I 2:24 would be thinking much more towards SLAP 2:26 lesion. Now if i push down since I kind 2:30 of have the AC joint in a locked and 2:32 loaded position here, and I push down and 2:35 I go where do you feel it and she goes 2:37 up top of her shoulder right, like right 2:40 where I could almost palpate where her 2:43 pain is, I'm going to start thinking AC 2:46 joint pathology. Now what do i do from 2:49 here, I've done my O'Brien's test, she has 2:52 pain at the top of her shoulder but this 2:55 really wasn't the test that I was going 2:58 to do, or I wasn't really thinking AC 3:00 joint pathology before this test; well I 3:03 would do what I do with all my tests, I 3:05 would start thinking towards my clusters. 3:07 If i did this and it was on the inside 3:09 of her shoulder that is her pains on the 3:11 inside of her shoulder, maybe I would 3:12 follow up with a couple more SLAP lesion 3:15 tests or labral pathology tests. If she 3:19 complains about pain on the top of her 3:21 shoulder I might follow up with a couple 3:24 more AC joint pain test to help me 3:27 differentiate those two diagnoses. Alright 3:30 so let's review one more time, 90 3:34 degrees of shoulder flexion, totally 3:36 internally rotated and pronated, 3:40 10 to 15 degrees of adduction, and then 3:43 I'm going to press down, I'm going to ask her is 3:45 that the symptoms that you were 3:47 describing? Does that hurt? Where does it 3:50 hurt? Inside her shoulder okay, we're not 3:54 done yet though, and then I'm going to 3:57 turn her all the way into external 3:58 rotation, completely supinated, push 4:02 down, how does that feel? That seems fine, 4:06 okay that's a positive O'Brien's. If she 4:09 has equal pain in both positions that 4:11 wouldn't be a positive O'Brien's. If she 4:14 has no pain in the first, but pain in the 4:15 second that's still not a positive 4:17 O'Brien's. It's only a positive O'Brien's 4:20 test if she has pain here and less or 4:23 no pain here. Thank you Melissa. Now with 4:27 all of our tests keep in mind guys no 4:30 test by itself is a good indicator of 4:35 really anything when it comes to these 4:38 special tests. They're only good 4:39 indicators when we take our subjective 4:41 evaluation, in Melissa's case we would 4:43 have wanted to know is she an overhead 4:45 athlete or an overhead worker, does she 4:48 do a lot of throwing, does she work in 4:49 construction, does she have to like for 4:53 example, maybe a stewardess has to lift 4:55 bags up into those really high bins on 4:58 planes, or you could think of like a 5:01 softball player has to throw a softball. 5:03 Anybody who has to do this, has to get 5:06 their arm up here, a lot that seems to be 5:09 indicative of labral pathology. Somebody 5:13 who's a little older, indicative of labral 5:15 pathology, labral pathologies are usually 5:18 acute in nature, they tend to not be 5:22 chronic, that is the person can remember 5:25 an instance where they started feeling 5:28 pain, and sometimes that's even attached 5:30 to some sort of trauma like running into 5:32 something or someone, or falling with an 5:35 outstretched arm. And then of course 5:37 we're going to take our one test and 5:40 we're going to cluster it with other 5:43 tests that are indicative of the 5:46 pathology we think might be related to 5:48 this person's symptoms. 5:49 So in the case of the O'Briens test we 5:52 know that it could be SLAP lesion or AC 5:56 joint pain, it's going to be important 5:58 for us to pair that with a couple more 6:00 tests for either SLAP lesion or and or 6:03 AC joint pain so that we get a good 6:06 indication of which direction where to 6:09 go.
