Cross Body Adduction Test

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 Cross Body Adduction Test


What is Cross Body Adduction Test?

Cross Body Adduction test (also called Cross chest adduction test or scarf test) is used to check for Acromioclavicular Joint pathology.

See Also: Clavicle Anatomy

How it’s Performed?

With the patient sitting or standing, the 90° abducted arm on the affected side is forcibly adducted across the chest toward the normal side

Cross Body Adduction Test

What does a positive Cross Body Adduction Test mean?

Dull, deep-seated pain over the superior scapular margin in the supraspinous fossa and posterolaterally on the scapula with radiation into the upper arm can be an indication of compression of the suprascapular nerve under the transverse scapular ligament by distal displacement of the scapula.

Sensitivity & Specificity

A study1 by Efstathios Chronopoulos for diagnostic value of physical tests for isolated chronic acromioclavicular lesions, he compared the three tests (acromioclavicular resisted extension test, active compression test and Cross Body Adduction Test) that is used in evaluation of acromioclavicular joint.

The accuracy of Cross Body Adduction Test was as following:

The study concludes that these tests have utility in evaluating patients with acromioclavicular joint pathologic lesions, and a combination of these physical tests is more helpful than isolated tests.

Another tests for Acromioclavicular Joint pathology include:

1. Dugas Test:

The patient is seated or standing and touches the contralateral shoulder with the hand of the 90°- flexed arm of the a affected side.

Acromioclavicular joint pain suggests joint disease (osteoarthritis, instability, disk injury, or infection). A differential diagnosis must exclude anterior subacromial impingement, due to the topographic proximity of that region.

Dugas Test
Dugas Test

2. Acromioclavicular Injection Test:

Inject the acromioclavicular joint with an anesthetic such as lidocaine (with a corticosteroid where indicated) using a proximal approach.

The injection must be performed under sterile conditions. Large osteophytes, arthritic joints, or a defective meniscus may render the injection into the anatomically narrow acromioclavicular joint space impossible.

If the injection relieves local pain, at least temporarily, this indicates that acromioclavicular pathology is present. To confirm the diagnosis it is recommended, while anesthesia persists, to attempt to reproduce the pain with whichever examination produced the most pain prior to injection, such as the cross-body adduction stress test or painful arc test.

3. Forced Adduction Test on Hanging Arm:

The examiner grasps the upper arm of the affected side with one hand while the other hand rests on the contralateral shoulder and immobilizes the shoulder girdle. Then the examiner forcibly adducts the hanging affected arm behind the patient’s back against the patient’s resistance.

Pain across the anterior aspect of the shoulder suggests acromioclavicular joint disease or subacromial impingement. (Symptoms that disappear or improve following injection of an anesthetic indicate that the acromioclavicular joint is causing the pain.)

Forced Adduction Test on Hanging Arm
Forced Adduction Test on Hanging Arm

4. Clavicle Mobility Test:

The examiner grasps the lateral end of the clavicle between two fingers and moves it in all directions.

Increased mobility of the lateral clavicle with or without pain is a sign of instability in the acromioclavicular joint.

In isolated osteoarthritis there will be circumscribed tenderness to palpation and pain with motion.

Acromioclavicular joint separation with rupture of the coracoclavicular ligaments will be accompanied by a positive “piano key” sign: the subluxated lateral end of the clavicle displaces proximally with the pull of the cervical musculature and can be pressed inferiorly against elastic resistance.

Clavicle Mobility Test
Clavicle Mobility Test

Notes

AC joint
Acromioclavicular (AC) joint

Reference

  1. Efstathios Chronopoulos, Tae Kyun Kim, Hyung Bin Park, Diane Ashenbrenner, Edward G McFarland.Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med . Apr-May 2004;32(3):655-61. doi: 10.1177/0363546503261723.PMID: 15090381
  2. Clinical Tests for the Musculoskeletal System, Third Edition
  3. Millers Review of Orthopaedics, 7th Edition



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