O'Brien's Test

What is O'Brien's Test

O'Brien's Test, also known as the O’Brien’s active compression test, is a clinical evaluation used to identify labral tears in the shoulder (O’Brien et al., 1998). While it can also be used to detect acromioclavicular (AC) joint abnormalities, the test is particularly useful for diagnosing superior labrum anterior to posterior (SLAP) lesions, a type of tear that occurs at the upper part of the shoulder’s labrum. The glenoid labrum is a ring of cartilage around the shoulder socket (glenoid) that helps stabilize the shoulder joint. A SLAP tear typically affects the labrum, where it attaches to the shoulder blade.

Here's how O'Brien's Test is typically performed:

1. With the patient standing, ask them to flex their shoulders to 90 degrees.
2. Move the patient’s arms so that the shoulders are horizontally adducted 10 to 15 degrees.
3. Ask the patient to internally rotate their arms to the maximum range (thumbs pointing downward). This is Position 1.
4. Apply downward force on the arms while the patient resists.
5. Next, ask the patient to externally rotate their arms (palms facing upward). This is Position 2.
6. Again, apply downward force and ask the patient to resist.

O'Brien's Test stresses the superior labrum to identify symptoms of a SLAP tear. However, doing other assessments is crucial for an accurate diagnosis and to gain a broader clinical context.

How to use our O'Brien's Test template

Our O’Brien’s Test template includes fields for recording test results, clear instructions, and images that demonstrate both test positions, making it a valuable tool for healthcare professionals. Here's how to use it:

Step 1: Access the template

You can access the template by clicking the "Use template" button to open it in the Carepatron app, or you can download a non-customizable PDF version. Printing the template can also help you keep it handy for quick reference.

Step 2: Assess the patient

Follow the test instructions by positioning the patient and performing the test as outlined above. Record the patient's responses to downward force in each test position. Be sure to note any differences in shoulder pain between positions.

Step 3: Interpret the results

Evaluate the test results based on the patient’s response to the downward pressure in each position. A positive test result suggests a SLAP lesion. Make sure to discuss the findings with the patient and consider follow-up diagnostic tests, such as imaging, for confirmation.

Why use O'Brien's Test for diagnosing labral tears?

O'Brien's Test diagnoses labral tears, specifically superior labral anterior to posterior (SLAP) lesions in the shoulder. Here are some reasons why this test is employed:

• Targeted stress on the labrum: O'Brien's Test involves specific movements (internal and external rotation) and positions (90 degrees of forward flexion and 10 to 15 degrees of horizontal adduction) that stress the superior labrum. This targeted stress helps elicit symptoms associated with labral tears.
• Differentiation of pain source: SLAP lesions can vary in severity and location. The test is designed to differentiate between pain arising from the labrum and other structures in the shoulder. The distinct phases of the test, involving internal and external rotation, help identify specific patterns of pain associated with a SLAP lesion.
• Non-invasive nature: O'Brien's Test is a non-invasive, relatively simple clinical test that can be performed in an office setting. It serves as an initial step in the diagnostic process before more advanced imaging studies, such as magnetic resonance imaging (MRI), are considered.
• Comparison with other tests: Various physical examination tests and imaging modalities are combined for diagnosing SLAP lesions. Some other commonly used provocative tests include the Speed Test, Yergason's Test, the Crank Test, and the Supine Flexion Resistance Test (a new SLAP test). Imaging studies, such as magnetic resonance arthrography (MRA) and magnetic resonance imaging (MRI), are also frequently employed.

However, like any diagnostic test, O'Brien's Test may yield false positives or negatives. False positives occur when the test suggests a problem that is not present, and false negatives occur when the test fails to identify an existing issue. Moreover, this test has a somewhat questionable to moderate diagnostic accuracy, with a sensitivity of 65% and specificity of 50% according to Buijze et al. (2023). This makes it vital to be thorough in clinical testing and use sound clinical judgment for a more accurate diagnosis.

What insights can positive test results provide about joint health?

Positive test results in O'Brien's Test, indicating pain or discomfort during the internal rotation phase and relief during the external rotation phase, can provide insights into potential joint pathology, specifically in the context of superior labral tears or SLAP lesions. Here are some implications of positive test results and the insights they may offer about joint health:

• SLAP lesions: O'Brien's Test is specifically designed to assess labral tears. A positive result suggests the possibility of a lesion, indicating damage or injury to the superior labrum.
• Differentiation from acromioclavicular (AC) joint abnormalities: O'Brien's Test helps differentiate between labral tears and issues related to the acromioclavicular (AC) joint. While AC joint abnormalities can also cause shoulder pain, a positive O'Brien's Test result suggests involvement of the superior labrum.
• The severity and clinical correlation: Pain during the internal rotation phase and relief during the external rotation phase may offer insights into the severity of the labral tear. However, the overall clinical picture, including the patient's history, symptoms, and additional diagnostic tests, should be considered to determine the extent of joint involvement.
• Treatment planning: Positive test results can guide healthcare professionals in formulating an appropriate treatment plan. This may involve further diagnostic imaging (such as MRI) to confirm the diagnosis and determine the extent of the tear. Treatment options can range from conservative measures, such as physical therapy, to surgical intervention, depending on the severity and impact on the patient's function.
• Follow-up and monitoring: Positive test results may prompt a healthcare provider to monitor the patient's condition and response to treatment closely. Follow-up assessments and imaging studies can help track healing progress or the effectiveness of interventions over time.

References

Buijze, G. A., Mariaux, S., van Spanning, S. H., Verweij, L. P. E., van Rijn, S. K., Lafosse, L., & Lafosse, T. (2022). The O’Brien Test demonstrates a higher diagnostic value in identifying posteroinferior labral tears than superior labral anterior to posterior (SLAP) tears. JSES International, 7(1). https://doi.org/10.1016/j.jseint.2022.10.006

O’Brien, S. J., Pagnani, M. J., Fealy, S., McGlynn, S. R., & Wilson, J. B. (1998). The Active Compression Test: A new and effective test for labral tears and acromioclavicular joint abnormality. The American Journal of Sports Medicine, 26(5), 610–613. https://doi.org/10.1177/03635465980260050201