O'Brien Test | Active Compression Test of O'Brien | SLAP Lesion
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- เผยแพร่เมื่อ 2 ต.ค. 2024
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This is not medical advice. The content is intended as educational content for health care professionals and students. If you are a patient, seek care of a health care professional. The O'Brien test is a test used to assess labral tears of the shoulder joint. The biceps load II test should be a more promising test as the anatomical mechanism of the o'brien are inconclusive.
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Thank you very much for posting the special orthopaedic tests. My final exam is in 8 weeks and this refresher information is invaluable. Further, the walk through (flow chart) for coming to a clinical impression is fantastic; I am struggling with this and your example has been of great benefit. Thank you again. Bridget
You're welcome Bridget! Good luck with your exam and thanks for following us!
Great illustrations, i love your videos. O’brien test was also shown to be 95% specifity for AC joint osteoarthritis.
amazing channel! thank you guys!
Appreciate it 💜
Very great sir am very thnkful for this
Hey guys, I've been doing some CPD and I actually found out that almost everyone does this test wrong, yourselves included. In the second test position you should supinate ONLY and not externally rotate the shoulder, by only supinating you can be sure the only structure you are changing at the shoulder is the biceps tendon. I learned this today from shoulder specialist Rod Whitely on a physio-network masterclass. If you go back to the original paper in which O,Brien described the test you'll see it described this way.
How can you physically supinate the wrist without the shoulder changing position as well?
@@1MILLIONARE1 because supination occurs at the radioulnar joint not the shoulder.
@@joesefr.7756 The only way I can supinate my hands completely without my shoulders externally rotate is if I bend my arms slightly
Thank you so much for your freaking absolutely amazing videos.10/12/2018 😃😃
why does the guy on here have to be so... easy on the eyes hahaha. but it's a good thing. makes us all want to pay attention hahaha
Trying to make our videos as visually appealing as possible!;)
Please lose weight next time before making such a suggestive comment like that.
@@anthonybacha2521 That comment is over 2 years old. Shut your mouth and get a life.
If the patient is finding pain whilst holding against the downward force being applied what treatment or exercises would you recommend for recovery? Thanks in advance
Thanks. Is this same test fr AC joint dislocation
My professor stated that the reason the internally rotated position increases the pain is the decreased space within the capsule.
It's a test for slap lesion, so the internal rotation position and Pronation of the elbow is thought to put more stress on the long biceps tendon
They go on to suggest that no one test is strong enough in isolation to accurately predict a SLAP lesion and "...all eight diagnostic tests for a SLAP lesion had likelihood ratios that were weak..." (p975) and conclude "...combinations of ShPE tests provide better accuracy, but marginally so." (p978).
1:28 💯 thanks for saying that I'm glad I'm not alone in thinking it's a totally trash test that makes no sense. Literally looking at a referral from an orthopedic doc right now saying both positive speeds and positive O'Briens and i thought, that's impossible... So I had to check my memory of how the test works lol
I have a test on upper body examinations and your videos are invaluable!! Thanks guys!!!
Glad you find them helpful
SAME!!!
HUY I LOVE YOU MEGAN
HUY WAG DTO HAHAHAHA ILYT 😝
O'Brien has injured his shoulder so many times, they named a test after it(jk)
(Star Trek joke/reference)
Sir can I contact u I am from Pakistan
what if the result is the opposite??
no pain in the first part of the test, a lot of pain in the second part?
the pain is felt near de LHB tendon, in front of the shoulder
This test alone does not say much an is not accurate.
@@Physiotutors understood, thank you.
thanks a lot, guys... a question: how does this test differ from the empty can test?
10-20° adduction, pronation position more painful than supinated position. Pain is usually felt deep in the joint.
SLAP lesion, or Superior Labrum Anterior and Posterior tear,
I appreciate the in-depth discussion of the utility of the test.
Glad you liked it
Great video!! One question, Iam a baseball pitcher and I feel pain when I move my arm behind the lower back (lumbar area), feel pain when I throwing the ball and clack my shoulder when I do the obrien test.
My Ultrasound diagnostics said: Osteoarthritis in the AC Joint.
What u think?
*Next week I have an MRI Arthrogram.
Hey Kelvo,
the O'Brien test is not a good diagnostic test to detect SLAP lesions.
The best advice is to get assessed by your local physio.
Often what is seen on MRI or X-ray will find a structure that could be damaged (also in asymptomatic people), but the pain is coming from somewhere else.
OA in the AC joint should usually show clinically in pain with end-range flexion+abduction (170-180°) and horizontal adduction of the shoulder joint.
If this is not the case I would not worry to much about it.
A great video that you should watch is the following by:
th-cam.com/video/5bUf9VcYLmI/w-d-xo.html
Thanks!
you are performing it the wrong way, as many do. you have to just supinate the forearm not EXTERNALLY ROTATE the arm. read the original research.
So This is essentially the empty can test
I have a slap tear of the superior labrum with fraying anterior yet I performed this test and I have no pain or discomfort. I do train a lot and do MMA/BJJ and weightlifting
I am diagnosed with slap tear. I was wondering why I feel more pain in the second test, this explains now ..
what is the difference between the sensitivity and the specificity?
Interesting videos! Interested in you paper citing, Dr. Hatch etal? USC KECK Medical?
it makes sense that sensitivity is >65% and that Green Et al stating second position activates biceps more leading to pulling of labrum/ should have no relief, meaning you can rule out (higher sensitivity and low specificity) SLAP lesions if the test is negative (no relief with external rotation/ second position)
"SLAP lesions: NOne of the 8 ShPE tests for which meta-analysis was possible (table 3) demonstrrted sensitivity values that would likely rule out a SLAP lesion with a negative test." (p 975).
I had an O'Brien Test performed, just the first example shown in the video. And my shoulder felt like it either slipped or dropped out of place and it hurt like a mother****. Do you have any idea what that might indicate?
Like mentioned in the video this can be indicative of a SLAP lesion, but also shoulder instability as well as a rotator cuff tear.
We'd propose to see a local physio or to get in touch with our partner yourphysio.online to get individualized counseling!
plz tell me the treatment of O'Briens test??
You waste a lot of time before getting to the actual test
No we don't.
So is there any new study prove the doubt?
This test is very similar to Empty can test
Good
Thanks for the great reaource. Specificity improves significantly when clustered with the Modified dynamic labral shear test
You're welcome Travis! Can you provide us with a link to pubmed? Coz Hegedus et al. (2012) describe it together in a cluster with the Passive Distraction Test as the best combination to detect SLAP lesions. (Actually a video we're gonna release in a couple of days)
Sure thing! www.ncbi.nlm.nih.gov/pmc/articles/PMC4610908/
"The modified dynamic labral shear demonstrated sensitivity of 72%, specificity of 98%, accuracy of 0.84, and a positive likelihood ratio of 31.57[39]. Combinations of clinical tests provide higher accuracy, in case of labral lesions, the best combination was identified to be the modified dynamic labral shear test and O’Brien’s maneuver."
Thanks for the article, now we also know which study Adam Meakins was referring to with 98% specificity.
However, there is a another study by Sodha et al. (2017) which evaluated the Dynamic Labral Shear Test and came to the following results: 78% Sens and 51% spec in isolated SLAP lesion and 57% sens and 51% specs in shoulders with concomitant pathology: www.ncbi.nlm.nih.gov/pubmed/28298065
For this reason, we will stick with the combination of the Passive Distraction Test and the Active Compression Test for now. At the same this combination is also based on just one study by Schlechter et al. so far.
Fan of your videos
Hey! First of all thnx for the the great work you do with these videos.
I`ve learned that O`brien originally performed this test differently. He did excactly like the first position, but different in the second position. He only changed the elbow position from pronated to a supinated position(reducing biceps tension), keeping the shoulder internal rotated. For me that makes more sense and is how i use it clinically. Maybe this change is the reason for the poor sensibility and specificity?
Thanks for your compliment and coment!
Just looked up the original description and you are right! Wondering though how O'Brien wants to go from a thumbs down position (maximal shoulder internal rotation and maximal pronation) to a palms up position only by movement in the elbow.
That would make 270° movement necessary and we got 180° at tops.
We might have to remake the video to keep the shoulder in the internally rotated position as much as possible.
The studies that have evaluated the test surely have performed this test according to its original description - still a lousy test...
I personally don`t do palms up, but maximum thumb up, maybe less. I am holding the patients arm right above the elbow and assist them in the supination controlling that the shoulder still is kept internal rotated. Palms up only supinating is some crazy kind of hypermobility! :D
I am little suprised that the studies have performed it like the original description. Because Ive learned that this test has been misunderstood and changed after some time. But I must admit I havent read the studies. So thanks for the information, Im for sure gonna be more critical whan using O`briens.
That's what we did first in our video and have thus received critique that this performance with thumbs up instead of palms up is not according to the original description of O'Brien!;)
This is the link to the original paper: www.ncbi.nlm.nih.gov/pubmed/9784804
Thanks for your input, very helpful to reflect on why we are performing a test a certain way from a biomechanical/anatomical point of view!
Why do PTs have such great physiques
Thanks a lot! Appreciate the username too Mr manager
Physiotutors omg! You guys just became a lot cooler in my eyes. Your vids are helpful for my exam. (But we just call it Manager)
Is it true that this test can be used to indicate AC pathalogy as well?
It's used in AC clusters as well. As a stand-alone test it's useless.
Thank you!!!
hi - i seem to have the opposite, the second position hurts but the first position is fine. what does this suggest?
Can't say anything based on this information. Also test results are never looked at in isolation but have to fit a clinical picture and the test itself has to have good diagnostic ability.
You are great at explaining!
Thanks, we're trying our best cansu!
Great video and commentary. Question, if the pain from the test is in the upper arm/biceps but not in the shoulder, is that still a positive test? Thanks! Also had a similar circumstance with the Yergason's test where the pain wasn't necessarily in the shoulder but at the top on the side of the arm. Speed's test was negative and apprehension test was positive with some anterior instability there. Thanks!
Thanks Jim! Officially you don't have a positive test for a SLAP lesion anymore, but we think it's more important anyways with all those special tests to understand what you are actually testing/stressing.
So in your case I would have rather thought of a muscle sprain given the location, but that's most probably unlikely due to the negative Speed's test. Hard to say from afar to be honest.
What does this test look like a combination of empty can test and speed's test?
This is true and most probably also a reason why this test lacks accuracy to distinguish between different conditions in the shoulder!
except that the empty can test is in the plane of the scapula...
I wonder if Kai is single...
Nope, both of us have girlfriends
I am having trouble understanding where in the Hegedus et al (2012)you found the sens and spec %s that you refer to. In Table 2, it clearly states that the active compression test was found to have a sensitivity of 91% and a specificity of 14%, which in fact makes this test more useful clinically than you suggest. Indeed, Hegedus et al (2012) go on to state "the modified dynamic labral shear test and O'Briens together show best prediction of SLAP arthroscopic findings" (Table 1, p968).I think some updates are in order...
the values you're referring are reports of one study that was included in the meta analysis. Hegedus meta-analysis (pooling) resulted in the values we state in the video. These can be found in table 3 of the referenced article by hegedus
you are correct - my apologies!
I was writing this at 5.30am after no sleep but that's a poor excuse....!
Prompt reply, by the way...:)
Does this mean that a Ukrainian translation doesn't figure high on your list of preferred languages to subtitle your videos?
Thanks for this! I've been trying to strengthen my rotator cuff the last 2 months by doing 3 sets of 20x with two rotator cuff exercises before all my workouts (3-4 times a week). I still have pain in my shoulder, sometimes radiating through some muscles in the shoulder/arm. But doing this test, man it's such a relief doing the second position, even on myself.