O’Brien Test

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 O’Brien Test


What is an O’Brien test?

O’Brien Test (also known as active compression test) is used to test for labral injuries and SLAP lesions (Superior Labrum Anterior and Posterior injuries) of the shoulder joint.

See Also: What is SLAP Lesion?

How do you perform an OBriens test?

The O’Brien test is a two-part test:

Stage 1:

O’Brien Test
Elbow extended, arm 10° adducted, 90° flexed, and maximally internally rotated

Stage 2:

O’Brien Test
with extended elbow, 90° flexion, and maximal external rotation of the 10° adducted arm.

What does a positive Obriens test mean?

The test is positive for a glenoid labral tear if the patient reports pain for clicking or pain “inside the shoulder” with resisted forward flexion in internal rotation of the shoulder that is relieved by External Rotation of the shoulder.

O’brien’s Test Accuracy

A study by J. Matthew Owen 2 shows that O’Brien test has a high Sensitivity and Specificity for detecting a SLAP tear, as following:

It also suggests that the O’Briens test has a high sensitivity (83%) and highly predictive (90%) of posterior labral injury.

Another study by William B Stetson 3 found that the O’Brien and Crank tests were not sensitive clinical indicators for detecting glenoid labral tears and other tears of the anterior and posterior labrum (O’Brien test has a Sensitivity of 54 %, and Specificity of 31 %).

Notes

SLAP lesion

SLAP lesion (Superior Labrum Anterior and Posterior injuries) can results from compressive loading of the shoulder in the flexed abducted position (for example, in a fall on the outstretched hand). The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the ‘anchor’ of the biceps tendon to the labrum.

There are four main types described:

  1. non-traumatic superior labral degeneration, usually in older people and often asymptomatic.
  2. Avulsion of the superior part of the labrum, the most common type.
  3. A ‘bucket handle’ tear of the superior labrum.
  4. As for type 3 with an extension into the tendon of Long Head of Biceps.

Very few patients with SLAP lesion injuries return to full capability without surgical intervention. Arthroscopic repair of an isolated superior labral lesion is successful in the large majority (91%) of patients. However, the results in patients who participate in overhead sports are not as satisfactory as those in patients who are not involved in overhead sports. Simple lesions are simply debrided. In more significant detachments the labrum is either repaired or excised with a tenotomy or tenodesis of the biceps.

Reference

  1. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 1998;26(5):610–613. PMID: 9784804
  2. J. Matthew Owen, Thomas Boulter, Mike Walton, Lennard Funk, and Tanya Anne Mackenzie. Reinterpretation of O’Brien test in posterior labral tears of the shoulder. Int J Shoulder Surg. 2015 Jan-Mar; 9(1): 6–8. PMCID: PMC4325388
  3. Stetson WB, Templin K. The crank test, the O’Brien test, and routine magnetic resonance imaging scans in the diagnosis of labral tears. Am J Sports Med 2002;30(6):806–809. PMID: 12435645.
  4. Clinical Tests for the Musculoskeletal System 3rd Edition.
  5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
  6. Apley and Solomon’s System of Orthopaedics and Trauma 10th Edition



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