Testing For Shoulder AC Joint Pains

I am used to doing an arm raised adduction test (bringing arm over chest) to see if it elicits pain.  Alarmingly , this crossed arm adduction test may only be positive 67% of the time. More sensitive tests have been devised.

First of all, the pain has to be in the area in question:

I have found plenty of AC joint tests that are positive in the posterior deltoid muscle and not on top of shoulder – they don’t count to me.

The standard test has been the crossed adduction test:

J Shoulder Elbow Surg. 2010 Sep 16. [Epub ahead of print]
Clinical evaluation of acromioclavicular joint pathology: Sensitivity of a new test.
van Riet RP, Bell SN.  abstract here

  • Used bone scan and response to injection of local and steroid as a guide
  • Found this classic test only positive 67% of time

O’Brien’s test – An improvement of this test was to adduct 10-15 °, turn arm so thumb down, and have them push up – this should hurt – then do it with palm up – this should hurt less. If the pain is felt on top – the it is AC joint, If it is felt inside and may clunk – then it’s a labral tear:

Present article pegged this at 83% sensitivity but felt the could do better…

The Bell-van Riet Test – They used same position as above with full adduction (as far as would go across chest  – then the had them push up – they found a 98% sensitivity.

Another way to test is the Paxinos test which reminds me of the Vulcan Nerve Pinch:

– Thumb on posterior acromium, index finger on mid-clavicle – and pinch the movement would be in the AC joint and so would the pain:
in : Walton J et al. Diagnostic values of tests for acromioclavicular joint pain. J Bone Joint Surg Am 2004;86-A:807-12.

found a 79% sensitivity and a 50% specificity. The did say that a Paxinos test and a negative bone scan combined had a great predictive value eliminating AC joint.

Probably the most sensitive test has to be direct pressure on the joint. “Local AC tenderness”

Any comments on tests?

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4 Responses to Testing For Shoulder AC Joint Pains

  1. Averal Brink says:

    I’ve been suffering from shoulder joint pain for months,blood tests,X-rays and scans done and no problem was found and my dr told me to take some tablets because there is nothing wrong with me,anyone have some advice other than physio,tried that as well.

    • k says:

      i have also been suffering pain for around 4 months. had xrays and scans and mine showed a smooth cartilage defect and also one of the bone that is supposed to be straight it sloping down pinching tendons.. u may have something like myself?

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  3. Pingback: AC Joint Treatments | Pain Medical Musing

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