00:00:0400:00:06
This is Brent of the Brookbush Institute
00:00:0600:00:07
and in this video we're going over the
00:00:0700:00:09
diagnostic cluster, for AC joint
00:00:0900:00:11
pathology. I'm going to have my friend
00:00:1100:00:12
Melissa step out, she's going to help me
00:00:1200:00:15
demonstrate. Now, this cluster is made up
00:00:1500:00:17
of three tests. These tests are the
00:00:1700:00:19
O'Briens active compression test, which
00:00:1900:00:21
you probably remember from the slap
00:00:2100:00:24
lesion or labral tear cluster that we
00:00:2400:00:26
taught. We then have the two commonly
00:00:2600:00:29
used AC joint tests being the crossbody
00:00:2900:00:32
or passive adduction test, as well as
00:00:3200:00:34
the resisted extension test, which we
00:00:3400:00:35
learned in a previous video, is actually
00:00:3500:00:37
resisted horizontal abduction and i know
00:00:3700:00:41
that's a little confusing, but we're
00:00:4100:00:42
going to go ahead and demonstrate these
00:00:4200:00:44
and the idea behind this cluster, is if
00:00:4400:00:47
you have two out of three or three out
00:00:4700:00:50
of three positives, you just increased
00:00:5000:00:52
your likelihood of having an accurate
00:00:5200:00:56
diagnosis. So, let's assume that Melissa
00:00:5600:00:59
walked in and she started in her
00:00:5900:01:03
subjective evaluation, here, giving me an
00:01:0300:01:04
indication that maybe she has something
00:01:0400:01:07
a little bit more than just shoulder
00:01:0700:01:09
impingement syndrome. So I started doing
00:01:0900:01:11
some other tests and let's say I get to
00:01:1100:01:14
O'Brien's active compression test. So
00:01:1400:01:16
let's review that real quick. O'Brien's
00:01:1600:01:17
active compression test, I would start
00:01:1700:01:19
with her arm in flexion. I would then
00:01:1900:01:20
turn her all the way into internal
00:01:2000:01:23
rotation and pronation. Horizontally adduct
00:01:2300:01:26
her 15 degrees and Melissa would
00:01:2600:01:30
resist a downward force. How does that
00:01:3000:01:33
feel? That hurts? Okay. So that
00:01:3300:01:34
replicates her symptoms but I'm not done
00:01:3400:01:40
here, where do you feel that? "Up top"
00:01:4000:01:42
Up top on your shoulder. Ok so she
00:01:4200:01:44
doesn't feel this in her shoulder, she
00:01:4400:01:48
feels this on top of her shoulder, which
00:01:4800:01:50
actually is more indicative of AC joint
00:01:5000:01:53
pathology, than labral pathology. We'll go
00:01:5300:01:56
ahead and finish O'Brien's test here. How
00:01:5600:02:00
does that feel? "Fine". So that's fine. Once again? "Pain".
00:02:0000:02:04
That's pain and where do you feel that?
00:02:0400:02:08
"Up top." So, she's definitely positive for
00:02:0800:02:11
O'Brien's, but the pain isn't where I would
00:02:1100:02:13
have expected, if it was a labral tear.
00:02:1300:02:16
It's on top, so already I'm thinking
00:02:1600:02:18
towards AC joint pathology,
00:02:1800:02:19
which is maybe where I would start
00:02:1900:02:23
tracking down my AC joint cluster. So, I
00:02:2300:02:25
could then follow that up with that
00:02:2500:02:27
passive adduction test. Right so, I'm
00:02:2700:02:29
gonna take her completely into
00:02:2900:02:31
horizontal adduction and give her a
00:02:3100:02:33
little over pressure. How does that feel?
00:02:3300:02:37
"Painful." That's painful too, ok, we're already two
00:02:3700:02:39
out of three, if you guys are tracking. So
00:02:3900:02:41
we're already pretty, we already have a
00:02:4100:02:43
pretty good indication, that it is AC
00:02:4300:02:47
joint. And then if I bring her to 90
00:02:4700:02:49
degrees of flexion, 90 degrees of
00:02:4900:02:51
horizontal adduction, 90 degrees of
00:02:5100:02:52
internal rotation, and 90 degrees of elbow
00:02:5200:02:54
flexion. Right, so her elbow was lined
00:02:5400:02:57
up and level with her shoulder and then
00:02:5700:02:59
she's a right angle here with her arm,
00:02:5900:03:01
and I have her try to push out the
00:03:0100:03:03
horizontal abduction. This being her
00:03:0300:03:06
resisted extension test, we talked about
00:03:0600:03:09
that. How does that feel? "Pain". That's also pain.
00:03:0900:03:11
That's three out of three. That's a
00:03:1100:03:14
really good indication, that she has some
00:03:1400:03:16
sort of AC joint pathology that we're
00:03:1600:03:21
going to have to work on here. Now, if she
00:03:2100:03:24
had gotten, let's say one out of three
00:03:2400:03:27
tests positive and she had two negatives,
00:03:2700:03:30
what we could follow this up with, which
00:03:3000:03:32
isn't necessarily part of this cluster,
00:03:3200:03:35
is we could follow up with palpation of
00:03:3500:03:37
the AC joint. Alright so, as we just
00:03:3700:03:40
discussed, O'Brien's can be positive for
00:03:4000:03:43
both a slap lesion and AC joint pain.
00:03:4300:03:47
The cross-body test is going to hurt if
00:03:4700:03:49
you have AC joint pathology, it's also
00:03:4900:03:51
going to hurt if you have impingement syndrome.
00:03:5100:03:53
Like it's just not going to
00:03:5300:03:55
feel good to get all crammed up in here,
00:03:5500:03:57
and have all of your rotator cuff
00:03:5700:03:59
tendons and stuff impinge, all those
00:03:5900:04:01
subacromial tissues. So if I came over
00:04:0100:04:06
here and i palpated and she said that
00:04:0600:04:09
this did not hurt, alright, so how does
00:04:0900:04:14
this feel? "Fine". That feels fine. Palpation is a
00:04:1400:04:16
sensitive but not a specific test, which
00:04:1600:04:19
means it's probably good as a clearance
00:04:1900:04:23
test, as in if she gets a negative test
00:04:2300:04:25
result, there's a high likelihood that
00:04:2500:04:29
she does not have AC joint pathology.
00:04:2900:04:30
Are you guys following me with all this
00:04:3100:04:34
So we have this testing cluster, that
00:04:3400:04:37
started with O'Brien's test. I did
00:04:3700:04:39
O'Brien's test and she said it hurt more
00:04:3900:04:42
over her AC joint. If I then go into my
00:04:4200:04:47
AC testing cluster, being O'Brien's cross-
00:04:4700:04:51
body and resisted extension and those
00:04:5100:04:54
are all positive, I have a good chance
00:04:5400:04:57
of it being positive. If I'm a little
00:04:5700:04:59
iffy, let's say I get a positive on
00:04:5900:05:03
O'Brien's, a positive on cross body, which
00:05:0300:05:04
are likely going to hurt with some of
00:05:0400:05:06
the other shoulder pathologies we have,
00:05:0600:05:08
but then I get a negative unresisted
00:05:0800:05:12
extension, I could then palpate and if I
00:05:1200:05:16
get a negative there too there's a good
00:05:1600:05:19
chance that we don't have AC joint
00:05:1900:05:21
pathology and maybe the complaint is
00:05:2100:05:24
more specific to her glenohumeral joint.
00:05:2400:05:27
Shall we go over that one more time?
00:05:2700:05:29
Here's what the test looks like, so, O'Brien's,
00:05:2900:05:33
flexion, right, how does this feel? "Pain"
00:05:3300:05:38
Pain, alright and then we turn over, "Nope". No pain,
00:05:3800:05:40
okay so that's a positive O'Brien's. I
00:05:4000:05:42
take her into cross-body give her a little
00:05:4200:05:47
over pressure. "Pain". That's painful, okay. Good.
00:05:4700:05:50
And then resisted extension test, push
00:05:5000:05:54
out, push towards me. "Pain." And that's pain.
00:05:5400:05:56
That's probably a pretty good indication
00:05:5600:06:01
that Melissa here, complaints are related
00:06:0100:06:03
to some sort of AC joint pathology. I
00:06:0300:06:05
hope you guys enjoyed this video. I hope
00:06:0500:06:08
you followed our logic and I hope that
00:06:0800:06:09
you'll start integrating these testing
00:06:0900:06:11
clusters into what you do in clinic,
00:06:1100:06:14
because they definitely have much higher
00:06:1400:06:17
reliability than any special test by
00:06:1700:06:19
itself. I'll look forward to seeing your
00:06:1900:06:22
comments and questions in the box below.