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Obrien's Active Compression Test

O'Brien's Active Compression Test is a manual examination used to detect shoulder impingement and assess shoulder muscle strength. This test is conducted by assessing the patient's ability to externally rotate the shoulder against resistance while the shoulder is being passively elevated. This test can be used to determine the cause of shoulder pain and rule out other possible diagnoses. By comparing the patient's abilities to resist against the external rotation force on both the affected and non-affected shoulders, abnormalities in strength can be easily

Transcript

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This is Brent of the Brookbush
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...blank
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Institute, in this video we're going over
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the special or orthopedic test the
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O'Briens test also known as the active
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compression test; which can be used to
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help indicate a SLAP lesion, which is a
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superior labral tear from anterior to
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posterior. There's some research to also
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show that it might be indicative of AC
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joint pathology, that's acromioclavicular
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joint pathology. I'm going to have my
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friend Melissa come ou,t she's going to
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help me demonstrate. Now the test itself
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is not difficult, it is a two-part test
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though. so I'm going to have Melissa go
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ahead and bring her arm up to 90 degrees
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of flexion, she's going to go ahead and
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pronate and internally rotate for me, and
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then horizontally adduct her arm 10 to 15
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degrees. I'm then going to apply a
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downward pressure, and I'm going to ask
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her is that the symptoms you were
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complaining about? Alright so that's pain.
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So she has pain in this position but
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when I have her supinate and kind of
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come back to neutral here in 90 degrees
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of flexion, and I pushed down, how does
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that feel?(Okay), that's fine, or even just
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less pain but that's a positive
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O'Brien's test. Alright so positive
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O'Brien's test would be when thumbs-down,
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internally rotated and adducted, I press
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down that's painful,
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this is less painful or not painful at
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all. Alright, you guys got that. Now where do we go
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from here. Well we have to make sure that
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we're actually testing for a SLAP tear
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and not that AC joint pathology I
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mentioned before. So when we were in this
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position just to add one more layer, alright
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making our diagnosis a little bit more
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specific. When I push down I would not
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only ask if she felt pain, does that
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replicate her symptoms, but I would also
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ask where do you feel that? (Inside my
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shoulder). Inside her shoulder, if it's inside
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her shoulder chances are we're looking
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at more of a SLAP lesion pathology right,
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even if she felt it down the front of
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her shoulder in that bicep tendon area I
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would be thinking much more towards SLAP
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lesion. Now if i push down since I kind
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of have the AC joint in a locked and
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loaded position here, and I push down and
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I go where do you feel it and she goes
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up top of her shoulder right, like right
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where I could almost palpate where her
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pain is, I'm going to start thinking AC
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joint pathology. Now what do i do from
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here, I've done my O'Brien's test, she has
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pain at the top of her shoulder but this
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really wasn't the test that I was going
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to do, or I wasn't really thinking AC
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joint pathology before this test; well I
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would do what I do with all my tests, I
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would start thinking towards my clusters.
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If i did this and it was on the inside
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of her shoulder that is her pains on the
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inside of her shoulder, maybe I would
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follow up with a couple more SLAP lesion
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tests or labral pathology tests. If she
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complains about pain on the top of her
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shoulder I might follow up with a couple
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more AC joint pain test to help me
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differentiate those two diagnoses. Alright
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so let's review one more time, 90
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degrees of shoulder flexion, totally
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internally rotated and pronated,
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10 to 15 degrees of adduction, and then
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I'm going to press down, I'm going to ask her is
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that the symptoms that you were
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describing? Does that hurt? Where does it
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hurt? Inside her shoulder okay, we're not
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done yet though, and then I'm going to
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turn her all the way into external
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rotation, completely supinated, push
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down, how does that feel? That seems fine,
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okay that's a positive O'Brien's. If she
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has equal pain in both positions that
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wouldn't be a positive O'Brien's. If she
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has no pain in the first, but pain in the
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second that's still not a positive
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O'Brien's. It's only a positive O'Brien's
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test if she has pain here and less or
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no pain here. Thank you Melissa. Now with
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all of our tests keep in mind guys no
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test by itself is a good indicator of
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really anything when it comes to these
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special tests. They're only good
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indicators when we take our subjective
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evaluation, in Melissa's case we would
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have wanted to know is she an overhead
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athlete or an overhead worker, does she
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do a lot of throwing, does she work in
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construction, does she have to like for
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example, maybe a stewardess has to lift
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bags up into those really high bins on
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planes, or you could think of like a
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softball player has to throw a softball.
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Anybody who has to do this, has to get
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their arm up here, a lot that seems to be
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indicative of labral pathology. Somebody
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who's a little older, indicative of labral
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pathology, labral pathologies are usually
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acute in nature, they tend to not be
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chronic, that is the person can remember
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an instance where they started feeling
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pain, and sometimes that's even attached
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to some sort of trauma like running into
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something or someone, or falling with an
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outstretched arm. And then of course
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we're going to take our one test and
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we're going to cluster it with other
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tests that are indicative of the
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pathology we think might be related to
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this person's symptoms.
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So in the case of the O'Briens test we
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know that it could be SLAP lesion or AC
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joint pain, it's going to be important
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for us to pair that with a couple more
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tests for either SLAP lesion or and or
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AC joint pain so that we get a good
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indication of which direction where to