The Paxinos Test is commonly used to assess symptom provocation associated with the acromioclavicular joint. This article explains the test protocol, interpretation, diagnostic considerations, limitations and practical recording guidance for structured shoulder assessment.

Introduction

Acromioclavicular (AC) joint pain commonly presents with:

• superior shoulder discomfort
• pain during pressing movements
• pain during cross-body movement
• tenderness over the AC joint
• discomfort during overhead loading

The Paxinos Test is one of several shoulder orthopaedic assessments used to reproduce symptoms associated with the AC joint region through controlled manual compression.

The test is commonly used alongside:

• AC joint palpation
• Scarf Test
• shoulder ROM assessment
• loading assessment
• symptom history
• movement assessment

Although a positive Paxinos Test may increase suspicion of AC joint irritability in some populations, it should not be interpreted as a stand-alone diagnostic tool.

Quick Summary

• Primary purpose: Assess AC joint symptom provocation
• Body region: Shoulder
• Commonly associated with: AC joint irritation and superior shoulder pain
• Positive finding: Reproduction of familiar AC joint symptoms
• Negative finding: No meaningful AC joint symptom reproduction
• Clinical role: Supports assessment reasoning but does not confirm pathology independently
• Best interpreted with: Palpation findings, symptom history and broader shoulder assessment

What Is the Paxinos Test?

The Paxinos Test is a shoulder orthopaedic assessment involving manual compression between the clavicle and acromion to stress the AC joint region.

The test is designed to:

• reproduce AC joint symptoms
• assess superior shoulder irritability
• evaluate tolerance to local compression
• support AC joint assessment reasoning

The assessment is most commonly used when AC joint involvement is suspected based on symptom location and loading behaviour.

Why It Is Used

The Paxinos Test may help:

• reproduce familiar AC joint pain
• assess superior shoulder symptom behaviour
• support shoulder assessment clusters
• guide further assessment
• monitor symptom irritability over time

The test may be particularly relevant in:

• contact athletes
• gym-based populations
• overhead athletes
• clients with superior shoulder pain
• clients reporting pain during pressing or cross-body movement

What It Assesses

The Paxinos Test is intended to assess:

• AC joint symptom provocation
• superior shoulder compression sensitivity
• local joint irritability
• tolerance to AC joint loading

A positive finding may suggest increased sensitivity involving the AC joint region. However, the test does not confirm structural pathology independently.

Who It Is Useful For

The Paxinos Test may be useful for:

• exercise professionals
• sports performance settings
• shoulder screening
• movement assessment education
• allied health assessment environments
• shoulder monitoring

When to Use This Test

Consider using the Paxinos Test when a client reports:

• superior shoulder pain
• tenderness over the AC joint
• pain during bench press or pressing movements
• pain during cross-body movement
• discomfort following shoulder contact injury
• painful overhead loading

The test may become more meaningful when combined with:

• AC joint palpation
• Scarf Test findings
• symptom history
• shoulder loading assessment
• movement assessment

When Not to Use or When to Be Cautious

Use caution when:

• acute fracture is suspected
• severe pain is present
• symptoms are highly irritable
• recent shoulder trauma occurred
• post-operative restrictions exist

Stop testing if:

• pain becomes excessive
• neurological symptoms occur
• the client requests cessation

Equipment Required

• Open assessment space
• Documentation system

No specialised equipment is required.

Step-by-Step Protocol / Practice

Setup

The client may sit or stand comfortably in a relaxed position.

Examiner/Professional Position

Stand beside the client while controlling the clavicle and scapular region.

Hand Placement

• Place one hand over the clavicle to stabilise it.
• Position the thumb of the opposite hand beneath the posterolateral acromion.

Compression Technique

1. Stabilise the clavicle.
2. Apply controlled upward pressure to the acromion.
3. Simultaneously apply downward pressure through the clavicle.
4. Compress the AC joint region gently.
5. Assess symptom response.

Instructions

Ask the client to:

• relax during testing
• report familiar pain
• describe symptom location
• report any sharp or local discomfort

Positive Finding

A positive finding may involve:

• reproduction of familiar AC joint pain
• local superior shoulder pain
• tenderness around the AC joint region

Negative Finding

A negative finding involves:

• no meaningful symptom reproduction
• absence of local AC joint discomfort

Positive and Negative Test Interpretation

Positive Test Interpretation

A positive Paxinos Test may increase suspicion of:

• AC joint irritability
• superior shoulder loading sensitivity
• AC joint-related symptom provocation

The finding may become more meaningful when combined with:

• local AC joint tenderness
• positive cross-body adduction testing
• painful pressing movements
• symptom history consistent with AC joint loading

However, the test does not confirm AC joint pathology independently.

Pain during the test may also relate to:

• general shoulder sensitivity
• local soft tissue irritation
• referred shoulder pain
• movement apprehension

Negative Test Interpretation

A negative finding may reduce suspicion of AC joint symptom provocation during manual compression.

However:

• AC joint symptoms may still exist
• symptoms may fluctuate depending on irritability
• additional shoulder assessment may still be appropriate

Normative Data, Benchmarks or Reference Values

There are currently no widely accepted normative values for the Paxinos Test because it is a symptom provocation assessment rather than a performance-based measurement test.

Interpretation is generally based on:

• presence or absence of familiar pain
• pain location
• symptom severity
• comparison with the opposite side
• consistency across repeated testing
• relationship to other shoulder findings

Practical comparison guidance may include:

• comparison with baseline findings
• symptom response over time
• tolerance to shoulder loading
• changes following activity modification or rehabilitation

Reliability and Validity

Research investigating AC joint tests suggests:

• isolated shoulder orthopaedic tests often have variable accuracy
• clustered findings may improve assessment usefulness
• symptom history and palpation remain important

Reliability may be influenced by:

• compression consistency
• hand placement
• symptom irritability
• examiner experience
• client guarding

At the time of writing:

• strong MDC, MCID and SEM values specific to the Paxinos Test remain limited

Sensitivity and Specificity

Published research investigating AC joint orthopaedic tests reports variable diagnostic accuracy depending on:

• study design
• reference standard
• population
• interpretation criteria

The Paxinos Test is generally considered more useful when combined with:

• AC joint palpation
• Scarf Test findings
• symptom history
• loading assessment

The test should not be interpreted as a stand-alone diagnostic assessment.

Common Errors and Limitations

Common errors include:

• excessive compression force
• inconsistent hand placement
• poor symptom clarification
• overinterpreting pain alone
• failure to compare findings with other assessments

Key limitations include:

• variable diagnostic accuracy
• overlap with other shoulder presentations
• symptom provocation may occur in multiple conditions
• limited stand-alone value

Practical Applications

The Paxinos Test may help:

• reproduce AC joint symptoms
• guide further shoulder assessment
• monitor symptom behaviour over time
• contribute to structured shoulder documentation
• support shoulder loading assessment

The test is often most useful alongside:

• palpation
• loading assessment
• ROM assessment
• movement assessment
• additional AC joint tests

How to Record This in Measurz

Record:

• Test name: Paxinos Test
• Side tested
• Positive, negative or unclear finding
• Pain location
• Pain score
• AC joint tenderness
• Symptom severity
• Compression response
• Comparison side findings
• Related shoulder findings
• Retest date

Related Tests / Internal Links

Related shoulder assessments may include:

• Scarf Test
• O’Brien’s Test
• AC Joint Palpation
• Hawkins-Kennedy Test
• Painful Arc

FAQs

What does the Paxinos Test assess?

The Paxinos Test assesses symptom provocation associated with the AC joint during manual compression.

Does the Paxinos Test diagnose AC joint pathology?

No. The test may contribute to assessment reasoning but does not confirm pathology independently.

What is considered a positive Paxinos Test?

A positive finding usually involves reproduction of familiar superior shoulder or AC joint pain.

Should the Paxinos Test be used alone?

No. Shoulder orthopaedic tests are generally more useful when interpreted alongside broader assessment findings.

Can the Paxinos Test reproduce pain in healthy shoulders?

Some discomfort may occur depending on compression force and local sensitivity, which is why symptom interpretation should consider the client’s full presentation.

Key Takeaways

• The Paxinos Test assesses AC joint symptom provocation during manual compression.
• A positive finding may increase suspicion of AC joint irritability.
• The test does not confirm structural pathology independently.
• Assessment findings are generally more useful when combined with broader shoulder examination results.
• Consistent positioning and recording improve repeatability and monitoring quality.

References

Cook, C., & Hegedus, E. J. (2021). Orthopedic physical examination tests: An evidence-based approach (3rd ed.). Pearson.

Krill, M. K., Borchers, J. R., & Hoffman, J. T. (2018). Physical examination of the shoulder. Sports Health, 10(4), 366–371. https://doi.org/10.1177/1941738118765734

Morrow, E. K., Morris, J. H., & Struyf, F. (2020). Clinical examination and physical assessment of shoulder pain. British Journal of Sports Medicine, 54(20), 1208–1215. https://doi.org/10.1136/bjsports-2019-101168

Pizzari, T., & Jaggi, A. (2021). Shoulder instability: Current approaches to assessment and management. Journal of Orthopaedic & Sports Physical Therapy, 51(7), 347–356. https://doi.org/10.2519/jospt.2021.0607