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 special
00:00:0700:00:09
orthopedic test for the
00:00:0900:00:11
acromioclavicular joint, the resisted
00:00:1100:00:13
extension test. I'm going to have my
00:00:1300:00:14
friend Melissa come out, she's going to
00:00:1400:00:17
help me demonstrate. Now I think you guys
00:00:1700:00:19
are going to see a small nomenclature or
00:00:1900:00:21
wording error in this test as we start
00:00:2100:00:24
to set it up. This test goes, I'm going to
00:00:2400:00:26
use one hand to brace her torso, so I'm
00:00:2600:00:28
going to do that fingers over the top of
00:00:2800:00:30
the scapula and then palm over the back
00:00:3000:00:31
of the scapula thing that you've seen in
00:00:3100:00:33
a lot of the videos we've done on
00:00:3300:00:35
special tests, and I'm going to use this
00:00:3500:00:39
hand to resist her arm once I put it in
00:00:3900:00:42
90 degrees of flexion, 90 degrees of
00:00:4200:00:44
horizontal adduction, 90 degrees of
00:00:4400:00:47
internal rotation, and 90 degrees of the
00:00:4700:00:49
elbow flexion. So this very squared up
00:00:4900:00:51
posture right, we got a nice little right
00:00:5100:00:53
angle here at her elbow, and then her
00:00:5300:00:55
elbow is both in line and level with
00:00:5500:00:57
her shoulder. Now here's where the
00:00:5700:00:59
nomenclature issue comes in, this is
00:00:5900:01:01
called the resisted extension test but
00:01:0100:01:03
what you're actually resisting is
00:01:0300:01:07
horizontal abduction. So if Melissa
00:01:0700:01:11
pushes her elbow out towards me that's
00:01:1100:01:14
the test right, this would be extension
00:01:1400:01:16
extensions a sagittal plane joint
00:01:1600:01:18
action, this is horizontal abduction or
00:01:1800:01:20
horizontal extension. So I'm not really
00:01:2000:01:22
sure what happened with the naming of
00:01:2200:01:25
this test, but make a note guys so that
00:01:2500:01:27
if you are using this test you don't get
00:01:2700:01:29
confused on where you should be
00:01:2900:01:33
resisting. So once again brace, resist,
00:01:3300:01:36
I'm just going to have a push out, ask
00:01:3600:01:38
her that telltale question, is that the
00:01:3800:01:39
symptoms you were talking about? That
00:01:3900:01:42
would be a positive if that replicates
00:01:4200:01:44
your symptoms, specifically if it
00:01:4400:01:47
replicates her symptoms at her AC joint
00:01:4700:01:50
that would be a positive. So i'm going to
00:01:5000:01:51
show you guys what that looks like at
00:01:5100:01:52
another angle, let me have you face that
00:01:5200:01:57
way. So again bring her up to elbow in
00:01:5700:01:59
line and level with your shoulder, and
00:01:5900:02:00
then 90 degrees of elbow flexion here,
00:02:0000:02:04
brace your torso, go ahead and resist,
00:02:0400:02:08
does that replicate your symptoms? Ok i'm
00:02:0800:02:10
going to show you guys the other way,
00:02:1000:02:14
good, you guys can see that brace hand. So
00:02:1400:02:17
I'm going to do this, this, so now I have
00:02:1700:02:19
control of her torso, I can push Melissa
00:02:1900:02:21
around a little bit, I've just got to be
00:02:2100:02:23
careful because she'll push back. Alright
00:02:2300:02:25
and then I'm going to use this hand to
00:02:2500:02:27
resist, you guys can see how I'm set up
00:02:2700:02:28
nice and strong, you guys can see I'm in
00:02:2800:02:31
a staggered stance. Go ahead and push out
00:02:3100:02:33
Melissa, good does that replicate your
00:02:3300:02:36
symptoms? All right I'm going to turn you
00:02:3600:02:38
guys back around one more time to see
00:02:3800:02:40
this view just to go over one other
00:02:4000:02:45
tendency I have. If Melissa had for
00:02:4500:02:48
example had a negative test result right,
00:02:4800:02:51
so I had to go ahead and push out, she's
00:02:5100:02:52
super strong and I go does that
00:02:5200:02:55
replicate your symptoms and she goes no,
00:02:5500:02:59
and then what I'll do is palpate the AC
00:02:5900:03:04
joint, so no pain there huh, and she says
00:03:0400:03:07
no after palpating the AC joint, a lot of
00:03:0700:03:09
times I'll sneak in that palpation
00:03:0900:03:12
because it is a very sensitive but not
00:03:1200:03:15
very specific test, which means if i get
00:03:1500:03:18
negatives for both her resisted
00:03:1800:03:22
extension test, and no pain when i'm
00:03:2200:03:25
pushing down on her AC joint I have a
00:03:2500:03:28
really good chance that it's not AC
00:03:2800:03:32
joint pathology. So tests that have high
00:03:3200:03:34
sensitivity of low specificity can be
00:03:3400:03:39
useful as screens if you get a negative
00:03:3900:03:41
test result. If I got a positive test
00:03:4100:03:43
result and I would probably want to add
00:03:4300:03:45
another couple other AC joint testing,
00:03:4500:03:47
we're going to talk about the AC joint
00:03:4700:03:50
cluster in another video. Thank You
00:03:5000:03:52
Melissa. As with all of these special
00:03:5200:03:55
orthopedic test guys we never use just
00:03:5500:03:57
one test, hopefully you guys now
00:03:5700:03:59
understand the technique behind this
00:03:5900:04:01
test, and you have one more tool in your
00:04:0100:04:05
arsenal as you start bringing tests
00:04:0500:04:08
together to build your case towards
00:04:0800:04:11
accurate diagnosis, hypothesis generation,
00:04:1100:04:14
and optimal intervention. I look forward
00:04:1400:04:16
to seeing your questions in the comments