Shoulder Orthopaedic Test: O'Briens Test

O'Brien's Test is a clinical test used to assess for a labral tear or SLAP (superior labrum anterior to posterior) lesion of the shoulder. It is also known as the active compression test.

Procedure:

1. The patient should be seated or standing with the affected arm in 90 degrees of shoulder flexion, 10-15 degrees of horizontal adduction, and the elbow fully extended.
2. The examiner should stand in front of the patient and stabilize the patient's scapula with one hand.
3. With the other hand, the examiner should passively internally rotate the patient's shoulder so that the thumb is pointing down (inverted).
4. The examiner then applies a downward force to the arm while the patient resists the force.
5. The same procedure is repeated with the shoulder passively externally rotated so that the thumb is pointing up (everted).
6. The examiner then applies a downward force to the arm while the patient resists the force.

During the test, the patient may experience pain or a clicking sensation in the shoulder. It is important to note that variations of the O'Brien's test have been described in the literature, so the specific procedure may vary slightly depending on the clinician.

The presence of pain or a clicking sensation deep within the shoulder during the internally rotated position, which is relieved during the externally rotated position, suggests a labral tear or SLAP lesion.

The sensitivity and specificity of O'Brien's test vary widely in the literature, with reported sensitivities ranging from 20% to 96% and specificities ranging from 38% to 100%. The diagnostic accuracy of the test may be improved when combined with other tests, such as the anterior slide test or the crank test.

References:

1. O'Brien SJ, Pagnani MJ, Fealy S, et al. 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.
2. Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42(2):80-92.