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Acromioclavicular (AC) Joint Test-item Cluster

The Acromioclavicular (AC) Joint Test-item Cluster is a collection of tests that evaluate the integrity, range of motion, and pain of the acromioclavicular joint, which connects the collarbone (clavicle) and shoulder blade (scapula). The test includes several static and dynamic movements; shoulder flexion, shoulder abduction, shoulder extension, shoulder external rotation, shoulder internal rotation, shoulder scaption, shoulder circumduction and shoulder isomet

Transcript

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