Facebook Pixel
Brookbush Institute Logo
Preview

Shouler Special Test Cluster: Labral Tear Cluster

Have shoulder pain? Learn how to diagnose Labral Tear Cluster with this helpful video. It covers the basics of how to perform the Shoulder Special Test Cluster, as well as recognizing and interpreting test results.

10 likes

Transcript

00:04 - 00:05This is Brent of the Brookbush Institute, and
00:05 - 00:07in this video we're going over special
00:07 - 00:09or orthopedic tests for the shoulder.
00:09 - 00:12Specifically how do we cluster tests to
00:12 - 00:14increase the specificity and sensitivity
00:14 - 00:18of our labral tear assessment. So the
00:18 - 00:19first problem we have is we have
00:19 - 00:21multiple research studies from multiple
00:21 - 00:24researchers, they don't always use the
00:24 - 00:27same test, nor the same message, nor the
00:27 - 00:30same analysis. So how do we pick that one
00:30 - 00:33set, or that one cluster of tests that
00:33 - 00:36we're going to use in the clinic. I think
00:36 - 00:38the best thing to do is probably start
00:38 - 00:40with some trends that we see across all
00:40 - 00:44of these studies, we can break the tests
00:44 - 00:46themselves into three groups. There
00:46 - 00:48seemed to be a correlation between the
00:48 - 00:51apprehension tests, that would be
00:51 - 00:53apprehension and Jobe's relocation, and
00:53 - 00:56labral tears. Kind of makes sense, if I
00:56 - 00:58tear my labrum I might lose a little
00:58 - 01:01shoulder stability. The second group of
01:01 - 01:03tests that are commonly used are the
01:03 - 01:06Speeds, and O'Brien's active compression
01:06 - 01:08test. We'll call those our standing
01:08 - 01:11flexion tests. All right so now we
01:11 - 01:14have our apprehension and our standing
01:14 - 01:17flexion test, there's a third group of
01:17 - 01:20tests used in one specific set of
01:20 - 01:22research that seems to increase
01:22 - 01:25specificity, and that's the bicep's load
01:25 - 01:292 or the compression rotation test. So
01:29 - 01:33now how do I choose. Well if we're going
01:33 - 01:37to just pick one study that actually
01:37 - 01:41used two good tests, and we're going to
01:41 - 01:45say good test is based on other research
01:45 - 01:47that looked at the reliability of one
01:47 - 01:51specific test at a time, we find that the
01:51 - 01:55Jobe's relocation and the O'Brien's active
01:55 - 01:58compression tests are two fairly good
01:58 - 02:02tests, that when combined increase the
02:02 - 02:05reliability of our assessment of labral
02:05 - 02:08tears. So we could just start there, use
02:08 - 02:11those two tests, but what about this
02:11 - 02:13third group that increases specificity.
02:13 - 02:15Well it'd be nice to grab the best of
02:15 - 02:17those two tests, especially considering
02:17 - 02:19the compression rotation test is
02:19 - 02:22actually a pretty bad test when it comes
02:22 - 02:23to specificity and sensitivity.
02:23 - 02:28Unfortunately if we add that third test,
02:28 - 02:31the only study we have that looked at
02:31 - 02:34adding that those tests added them both,
02:34 - 02:40right so now we have the Biceps load 2, the
02:40 - 02:43compression rotation and O'Brien's test
02:43 - 02:46combined. and that's not exactly how I
02:46 - 02:49would have created that cluster, right we
02:49 - 02:51just lost our apprehension test which
02:51 - 02:53seemed to be correlated with our labral
02:53 - 02:56tears, and we have to include this one
02:56 - 03:00test that like I said is not a great
03:00 - 03:02test, and if I could I would sweep it
03:02 - 03:06away. So where do we go from here? Well if
03:06 - 03:10you're me I'm going to take a chance, i'm
03:10 - 03:12going to use Jobe's relocation and
03:12 - 03:15O'Brien's active compression which I
03:15 - 03:17know work well together, and I'm going to
03:17 - 03:20add biceps load 2 which seems to
03:20 - 03:23increase specificity, despite the fact
03:23 - 03:26that i don't have one study on the three
03:26 - 03:29of those tests combined. So what does
03:29 - 03:31that look like, I'm going to have my
03:31 - 03:33friend Melissa come out she's going to
03:33 - 03:37help me demonstrate. So first things
03:37 - 03:40first, let's say Melissa came in and she
03:40 - 03:43complaining about an acute trauma. She
03:43 - 03:45remembers when she first started
03:45 - 03:47having that pain, maybe it even started
03:47 - 03:49with a click or a pop, she happens to be
03:49 - 03:51an overhead athlete, maybe she's a
03:51 - 03:54volleyball player right, and this pain
03:54 - 03:55started about a week, week and a half ago
03:55 - 03:57and it doesn't seem to want to go away.
03:57 - 04:00All right I got a good sense that labral
04:00 - 04:04tear could be a possible diagnosis. I'm
04:04 - 04:06going to start with my O'Brien test. My
04:06 - 04:07O'Brien test -I'm going to have Melissa
04:07 - 04:10go ahead and lift her arm up to 90
04:10 - 04:11degrees, i'm going to have her turn in
04:11 - 04:14completely. I'm going to put some
04:14 - 04:16downward force through her arm, and if
04:16 - 04:19she complains about pain inside her
04:19 - 04:22shoulder,
04:22 - 04:25and then when I do it this way right so
04:25 - 04:26completely externally rotateD and
04:26 - 04:30supinated, she says that either feels
04:30 - 04:32better as in less pain, or there's no
04:32 - 04:35pain at all that's a positive O'Brien's
04:35 - 04:39test, I'm now 1 for 3 right. So she has pain
04:39 - 04:42inside her shoulder, not to be confused
04:42 - 04:43with pain on top of her shoulder. She
04:43 - 04:45has pain inside her shoulder when I do
04:45 - 04:50this, but less pain when I do that. Okay
04:50 - 04:53that's one positive test. I'm then
04:53 - 04:55going to ask Melissa to lie
04:55 - 04:59down. Now I'm going to do Jobe's relocation
04:59 - 05:01which is a modification on my
05:01 - 05:02apprehension test. Can you scoot this way
05:02 - 05:05just a little bit Melissa. If I was doing
05:05 - 05:08Jobe's relocation this wouldn't feel very
05:08 - 05:11good, as soon as I got here she'd start
05:11 - 05:12to guard on me. She might not even have
05:12 - 05:14pain, she'll just guard, she just doesn't
05:14 - 05:17want me to let her go back there, but if
05:17 - 05:20I give her some external stabilization
05:20 - 05:24of her humeral head, now she'll let me go
05:24 - 05:26back and she'll even tell me that
05:26 - 05:30this feels better. Alright so a little
05:30 - 05:33anterior compression, a little false
05:33 - 05:35stabilization of her humeral head and
05:35 - 05:39she's feeling better. If that's the case
05:39 - 05:42it's a positive Jobe's relocation test. Now
05:42 - 05:46I have two strikes, and or two points
05:46 - 05:50towards a diagnosis of labral tear. The
05:50 - 05:52last one is I'm going to have Melissa
05:52 - 05:53scoot over just a little bit that way.
05:53 - 05:57I'm going to make sure that her scapula
05:57 - 05:59is a neutral position. I'm going to take
05:59 - 06:00her up to about a hundred and thirty
06:00 - 06:02degrees of abduction, and then I'm going
06:02 - 06:06to go -hey slowly can you just kind of flex
06:06 - 06:10your bicep for me. There you go, and if
06:10 - 06:13she complained of pain again, this
06:13 - 06:17replicated her symptoms, I'd be three for
06:17 - 06:20three that'd be a positive biceps load
06:20 - 06:262, and I'd have another piece of
06:26 - 06:30evidence towards a labral tear. Alright
06:30 - 06:33so remember what I told you at the
06:33 - 06:34beginning of this,
06:34 - 06:37there's a lot of research it doesn't
06:37 - 06:39necessarily conflict but it doesn't
06:39 - 06:42exactly match either. If you were going
06:42 - 06:47to use two tests that are backed by a
06:47 - 06:50research study, that we do have evidence
06:50 - 06:52third-party evidence that when the two
06:52 - 06:55tests are combined we get higher
06:55 - 06:58specificity and sensitivity, just go with
06:58 - 07:01O'Brien's and Jobe's relocation. You could
07:01 - 07:04also go with speeds and apprehension, but
07:04 - 07:06like i said i think O'Brien's and Jobe's
07:06 - 07:08relocation are the better of those tests.
07:08 - 07:13If you add biceps load 2 you might be
07:13 - 07:16increasing your specificity, but we don't
07:16 - 07:19have a particular study to pull that all
07:19 - 07:22together. I hope to see a study like that
07:22 - 07:27very soon. So just out of total humility
07:27 - 07:30and knowing that there are other answers
07:30 - 07:32out there, the Brookbush Institute
07:32 - 07:35cluster the best thing I can figure out
07:35 - 07:38based on the research I've seen, would be
07:38 - 07:42Jobe's relocation along with O'Brien's active
07:42 - 07:44compression, along with biceps load
07:44 - 07:462. I hope you guys enjoyed this video. I
07:46 - 07:48hope you guys will give these three
07:48 - 07:51tests some practice. I hope you at least
07:51 - 07:54start taking steps towards integrating
07:54 - 07:56testing clusters for all of your various
07:56 - 07:59pathologies into your clinics. I look
07:59 - 08:01forward to seeing your questions, and
08:01 - 08:04we'll talk to you soon.
08:10 - 08:12

Comments

Guest

3 Certifications, 165+ Courses, 500+ videos, and so much more!

The Brookbush Institute (BI) continues to improve affordability, access, flexibility, and convenience to the highest-quality education.

The Bl is the only approved/accredited certification and continuing education course provider with a true monthly membership model (cancel anytime).

This reduces the initial cost of education to just 3-5% of comparable education, improving access to complete, continue, or just "try" education with low financial risk. Don't get fooled by great marketing to make a large purchase for potentially sub-optimal education. Become a member, and find out why we think this is the way education should be!


or
Sign Up with Email Address
Already Have an Account? Sign In