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Shouler Special Test Cluster: Labral Tear Cluster
The Shoulder Special Test Cluster - Labral Tear Cluster is an assessment tool used to help diagnose possible labral tears in the shoulder. This evaluation consists of a series of four tests, including the Apprehension Test, Drop Arm Test, Load and Shift Test, and Sulcus Sign. Each test is designed to look for abnormal movements, tenderness, and clicks which indicate the presence of a labral tear. The results of this test can provide vital information to help guide further diagnostic
Transcript
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This is Brent of the Brookbush Institute, and
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...blank
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in this video we're going over special
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or orthopedic tests for the shoulder.
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Specifically how do we cluster tests to
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increase the specificity and sensitivity
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of our labral tear assessment. So the
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first problem we have is we have
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multiple research studies from multiple
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researchers, they don't always use the
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same test, nor the same message, nor the
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same analysis. So how do we pick that one
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set, or that one cluster of tests that
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we're going to use in the clinic. I think
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the best thing to do is probably start
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with some trends that we see across all
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of these studies, we can break the tests
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themselves into three groups. There
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seemed to be a correlation between the
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apprehension tests, that would be
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apprehension and Jobe's relocation, and
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labral tears. Kind of makes sense, if I
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tear my labrum I might lose a little
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shoulder stability. The second group of
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tests that are commonly used are the
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Speeds, and O'Brien's active compression
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test. We'll call those our standing
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flexion tests. All right so now we
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have our apprehension and our standing
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flexion test, there's a third group of
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tests used in one specific set of
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research that seems to increase
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specificity, and that's the bicep's load
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2 or the compression rotation test. So
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now how do I choose. Well if we're going
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to just pick one study that actually
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used two good tests, and we're going to
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say good test is based on other research
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that looked at the reliability of one
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specific test at a time, we find that the
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Jobe's relocation and the O'Brien's active
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compression tests are two fairly good
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tests, that when combined increase the
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reliability of our assessment of labral
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tears. So we could just start there, use
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those two tests, but what about this
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third group that increases specificity.
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Well it'd be nice to grab the best of
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those two tests, especially considering
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the compression rotation test is
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actually a pretty bad test when it comes
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to specificity and sensitivity.
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Unfortunately if we add that third test,
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the only study we have that looked at
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adding that those tests added them both,
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right so now we have the Biceps load 2, the
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compression rotation and O'Brien's test
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combined. and that's not exactly how I
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would have created that cluster, right we
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just lost our apprehension test which
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seemed to be correlated with our labral
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tears, and we have to include this one
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test that like I said is not a great
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test, and if I could I would sweep it
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away. So where do we go from here? Well if
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you're me I'm going to take a chance, i'm
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going to use Jobe's relocation and
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O'Brien's active compression which I
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know work well together, and I'm going to
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add biceps load 2 which seems to
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increase specificity, despite the fact
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that i don't have one study on the three
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of those tests combined. So what does
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that look like, I'm going to have my
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friend Melissa come out she's going to
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help me demonstrate. So first things
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first, let's say Melissa came in and she
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complaining about an acute trauma. She
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remembers when she first started
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having that pain, maybe it even started
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with a click or a pop, she happens to be
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an overhead athlete, maybe she's a
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volleyball player right, and this pain
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started about a week, week and a half ago
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and it doesn't seem to want to go away.
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All right I got a good sense that labral
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tear could be a possible diagnosis. I'm
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going to start with my O'Brien test. My
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O'Brien test -I'm going to have Melissa
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go ahead and lift her arm up to 90
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degrees, i'm going to have her turn in
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completely. I'm going to put some
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downward force through her arm, and if
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she complains about pain inside her
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shoulder,
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and then when I do it this way right so
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completely externally rotateD and
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supinated, she says that either feels
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better as in less pain, or there's no
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pain at all that's a positive O'Brien's
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test, I'm now 1 for 3 right. So she has pain
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inside her shoulder, not to be confused
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with pain on top of her shoulder. She
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has pain inside her shoulder when I do
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this, but less pain when I do that. Okay
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that's one positive test. I'm then
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going to ask Melissa to lie
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down. Now I'm going to do Jobe's relocation
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which is a modification on my
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apprehension test. Can you scoot this way
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just a little bit Melissa. If I was doing
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Jobe's relocation this wouldn't feel very
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good, as soon as I got here she'd start
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to guard on me. She might not even have
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pain, she'll just guard, she just doesn't
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want me to let her go back there, but if
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I give her some external stabilization
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of her humeral head, now she'll let me go
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back and she'll even tell me that
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this feels better. Alright so a little
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anterior compression, a little false
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stabilization of her humeral head and
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she's feeling better. If that's the case
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it's a positive Jobe's relocation test. Now
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I have two strikes, and or two points
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towards a diagnosis of labral tear. The
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last one is I'm going to have Melissa
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scoot over just a little bit that way.
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I'm going to make sure that her scapula
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is a neutral position. I'm going to take
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her up to about a hundred and thirty
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degrees of abduction, and then I'm going
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to go -hey slowly can you just kind of flex
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your bicep for me. There you go, and if
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she complained of pain again, this
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replicated her symptoms, I'd be three for
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three that'd be a positive biceps load
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2, and I'd have another piece of
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evidence towards a labral tear. Alright
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so remember what I told you at the
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beginning of this,
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there's a lot of research it doesn't
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necessarily conflict but it doesn't
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exactly match either. If you were going
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to use two tests that are backed by a
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research study, that we do have evidence
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third-party evidence that when the two
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tests are combined we get higher
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specificity and sensitivity, just go with
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O'Brien's and Jobe's relocation. You could
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also go with speeds and apprehension, but
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like i said i think O'Brien's and Jobe's
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relocation are the better of those tests.
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If you add biceps load 2 you might be
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increasing your specificity, but we don't
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have a particular study to pull that all
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together. I hope to see a study like that
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very soon. So just out of total humility
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and knowing that there are other answers
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out there, the Brookbush Institute
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cluster the best thing I can figure out
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based on the research I've seen, would be
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Jobe's relocation along with O'Brien's active
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compression, along with biceps load
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2. I hope you guys enjoyed this video. I
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hope you guys will give these three
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tests some practice. I hope you at least
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start taking steps towards integrating
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testing clusters for all of your various
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pathologies into your clinics. I look
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forward to seeing your questions, and
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we'll talk to you soon.
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