0:04 This is Brent of the Brookbush Institute 0:06 and in this video we're going over the 0:07 diagnostic cluster, for AC joint 0:09 pathology. I'm going to have my friend 0:11 Melissa step out, she's going to help me 0:12 demonstrate. Now, this cluster is made up 0:15 of three tests. These tests are the 0:17 O'Briens active compression test, which 0:19 you probably remember from the slap 0:21 lesion or labral tear cluster that we 0:24 taught. We then have the two commonly 0:26 used AC joint tests being the crossbody 0:29 or passive adduction test, as well as 0:32 the resisted extension test, which we 0:34 learned in a previous video, is actually 0:35 resisted horizontal abduction and i know 0:37 that's a little confusing, but we're 0:41 going to go ahead and demonstrate these 0:42 and the idea behind this cluster, is if 0:44 you have two out of three or three out 0:47 of three positives, you just increased 0:50 your likelihood of having an accurate 0:52 diagnosis. So, let's assume that Melissa 0:56 walked in and she started in her 0:59 subjective evaluation, here, giving me an 1:03 indication that maybe she has something 1:04 a little bit more than just shoulder 1:07 impingement syndrome. So I started doing 1:09 some other tests and let's say I get to 1:11 O'Brien's active compression test. So 1:14 let's review that real quick. O'Brien's 1:16 active compression test, I would start 1:17 with her arm in flexion. I would then 1:19 turn her all the way into internal 1:20 rotation and pronation. Horizontally adduct 1:23 her 15 degrees and Melissa would 1:26 resist a downward force. How does that 1:30 feel? That hurts? Okay. So that 1:33 replicates her symptoms but I'm not done 1:34 here, where do you feel that? "Up top" 1:40 Up top on your shoulder. Ok so she 1:42 doesn't feel this in her shoulder, she 1:44 feels this on top of her shoulder, which 1:48 actually is more indicative of AC joint 1:50 pathology, than labral pathology. We'll go 1:53 ahead and finish O'Brien's test here. How 1:56 does that feel? "Fine". So that's fine. Once again? "Pain". 2:00 That's pain and where do you feel that? 2:04 "Up top." So, she's definitely positive for 2:08 O'Brien's, but the pain isn't where I would 2:11 have expected, if it was a labral tear. 2:13 It's on top, so already I'm thinking 2:16 towards AC joint pathology, 2:18 which is maybe where I would start 2:19 tracking down my AC joint cluster. So, I 2:23 could then follow that up with that 2:25 passive adduction test. Right so, I'm 2:27 gonna take her completely into 2:29 horizontal adduction and give her a 2:31 little over pressure. How does that feel? 2:33 "Painful." That's painful too, ok, we're already two 2:37 out of three, if you guys are tracking. So 2:39 we're already pretty, we already have a 2:41 pretty good indication, that it is AC 2:43 joint. And then if I bring her to 90 2:47 degrees of flexion, 90 degrees of 2:49 horizontal adduction, 90 degrees of 2:51 internal rotation, and 90 degrees of elbow 2:52 flexion. Right, so her elbow was lined 2:54 up and level with her shoulder and then 2:57 she's a right angle here with her arm, 2:59 and I have her try to push out the 3:01 horizontal abduction. This being her 3:03 resisted extension test, we talked about 3:06 that. How does that feel? "Pain". That's also pain. 3:09 That's three out of three. That's a 3:11 really good indication, that she has some 3:14 sort of AC joint pathology that we're 3:16 going to have to work on here. Now, if she 3:21 had gotten, let's say one out of three 3:24 tests positive and she had two negatives, 3:27 what we could follow this up with, which 3:30 isn't necessarily part of this cluster, 3:32 is we could follow up with palpation of 3:35 the AC joint. Alright so, as we just 3:37 discussed, O'Brien's can be positive for 3:40 both a slap lesion and AC joint pain. 3:43 The cross-body test is going to hurt if 3:47 you have AC joint pathology, it's also 3:49 going to hurt if you have impingement syndrome. 3:51 Like it's just not going to 3:53 feel good to get all crammed up in here, 3:55 and have all of your rotator cuff 3:57 tendons and stuff impinge, all those 3:59 subacromial tissues. So if I came over 4:01 here and i palpated and she said that 4:06 this did not hurt, alright, so how does 4:09 this feel? "Fine". That feels fine. Palpation is a 4:14 sensitive but not a specific test, which 4:16 means it's probably good as a clearance 4:19 test, as in if she gets a negative test 4:23 result, there's a high likelihood that 4:25 she does not have AC joint pathology. 4:29 Are you guys following me with all this 4:30 logic? 4:31 So we have this testing cluster, that 4:34 started with O'Brien's test. I did 4:37 O'Brien's test and she said it hurt more 4:39 over her AC joint. If I then go into my 4:42 AC testing cluster, being O'Brien's cross- 4:47 body and resisted extension and those 4:51 are all positive, I have a good chance 4:54 of it being positive. If I'm a little 4:57 iffy, let's say I get a positive on 4:59 O'Brien's, a positive on cross body, which 5:03 are likely going to hurt with some of 5:04 the other shoulder pathologies we have, 5:06 but then I get a negative unresisted 5:08 extension, I could then palpate and if I 5:12 get a negative there too there's a good 5:16 chance that we don't have AC joint 5:19 pathology and maybe the complaint is 5:21 more specific to her glenohumeral joint. 5:24 Shall we go over that one more time? 5:27 Here's what the test looks like, so, O'Brien's, 5:29 flexion, right, how does this feel? "Pain" 5:33 Pain, alright and then we turn over, "Nope". No pain, 5:38 okay so that's a positive O'Brien's. I 5:40 take her into cross-body give her a little 5:42 over pressure. "Pain". That's painful, okay. Good. 5:47 And then resisted extension test, push 5:50 out, push towards me. "Pain." And that's pain. 5:54 That's probably a pretty good indication 5:56 that Melissa here, complaints are related 6:01 to some sort of AC joint pathology. I 6:03 hope you guys enjoyed this video. I hope 6:05 you followed our logic and I hope that 6:08 you'll start integrating these testing 6:09 clusters into what you do in clinic, 6:11 because they definitely have much higher 6:14 reliability than any special test by 6:17 itself. I'll look forward to seeing your 6:19 comments and questions in the box below. 6:29 you
