O’Brien Test

O’Brien’s test, also known as the active compression test, is a clinical maneuver used to evaluate for labral tears or other pathology within the shoulder joint, particularly the glenoid labrum. Here’s how it’s performed:

  1. Patient Positioning: The patient typically stands or sits comfortably.
  2. Examiner Positioning: The examiner stands facing the patient.
  3. Procedure:
    • The examiner instructs the patient to fully flex the shoulder to 90 degrees and adduct it across the body (bringing the arm toward the opposite shoulder).
    • The patient then internally rotates the arm so that the thumb points downward (pronation).
    • With the arm in this position, the examiner applies a downward force on the arm while the patient resists. This is typically done by the examiner placing one hand on the patient’s wrist and the other on the patient’s elbow to stabilize the shoulder.
    • The examiner then repeats the same maneuver, but with the patient’s arm externally rotated so that the thumb points upward (supination).
  4. Interpretation:
    • Pain elicited during the maneuver with the arm internally rotated (thumb pointing downward) and relieved when the arm is externally rotated (thumb pointing upward) is considered a positive sign for a labral tear, particularly a superior labral tear from anterior to posterior (SLAP) lesion.
    • If the pain remains the same or worsens with external rotation, it may suggest other pathology such as AC joint issues or rotator cuff pathology.
  5. Clinical Significance:
    • O’Brien’s test is particularly useful in assessing for SLAP lesions, which are tears of the labrum that occur at the top (superior) portion of the glenoid socket where the biceps tendon attaches.
    • SLAP lesions can cause pain, clicking, or instability in the shoulder, especially during activities that involve overhead motion or forceful arm movements.
    • However, a positive O’Brien’s test does not definitively diagnose a SLAP lesion; it indicates the need for further evaluation with imaging studies such as MRI or arthroscopy.
  6. Considerations:
    • O’Brien’s test should be performed carefully to avoid exacerbating the patient’s symptoms.
    • It’s essential to correlate the results of O’Brien’s test with other clinical findings, imaging studies, and the patient’s history to arrive at an accurate diagnosis and treatment plan.

Overall, O’Brien’s test is a valuable clinical tool used by healthcare professionals to assess for labral tears, particularly SLAP lesions, in patients with shoulder pain or instability.

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