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This is Brent of the Brookbush
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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