Paxinos Test

What is acromioclavicular joint pain?

Acromioclavicular (AC) joint pain is a common condition that affects the small joint at the top of the shoulder where the acromion (part of the scapula) meets the clavicle (collarbone). This joint is crucial for shoulder movement and stability. When it becomes injured or inflamed, it can cause significant pain and discomfort.

Symptoms of this type of pain

Acromioclavicular joint pain is often characterized by:

• Pain on the top of the shoulder
• Pain that worsens with overhead activities
• Swelling and tenderness over the AC joint
• Reduced range of motion in the shoulder
• Clicking or popping sensation when moving the shoulder

Causes of this pain

The causes of acromioclavicular joint pain can include:

• Trauma or injury, such as a fall onto the shoulder
• Overuse or repetitive strain, especially in athletes
• Arthritis, including osteoarthritis and rheumatoid arthritis
• Degenerative changes due to aging
• Previous shoulder surgeries

What is the Paxinos Test?

The Paxinos Test is performed with the patient seated, ensuring the symptomatic affected arm is relaxed by their side. The examiner stands beside the patient and places their thumb under the posterolateral aspect of the affected arm at the acromion while positioning the index and middle fingers superior to the mid-clavicle.

The examiner then applies pressure in two directions: anterosuperior pressure to the acromion with the thumb and inferior pressure to the mid-clavicle with the index and middle fingers. This dual-pressure maneuver aims to provoke pain or discomfort in the acromioclavicular joint.

Lastly, the examiner monitors the patient's response throughout the test to determine the presence of pain, specifically in the AC joint region.

How are the results interpreted?

The results of the Paxinos Test are interpreted based on the patient's pain response. A positive result is indicated if the patient experiences pain or increased discomfort in the region of the acromioclavicular joint when pressure is applied. This suggests that the pain may originate from the AC joint, possibly due to inflammation, arthritis, or other AC joint pathology.

Conversely, a negative result is indicated if there is no significant pain response during the test. This suggests that the AC joint is likely not the source of the shoulder pain, and other potential causes should be considered.

The Paxino test has a 79% sensitivity (Walton et al., 2004), which means further evaluation may be needed to confirm a diagnosis of acromioclavicular joint pain. However, when combined with the O'Brien test, the series achieves a specificity of 95.8% ((Krill et al., 2017)

Next steps after conducting this test

After conducting the Paxinos Test, the following steps depend on the test results. If the test result is positive, further diagnostic imaging, such as X-rays or MRI, may be ordered to confirm the diagnosis and assess the severity of the condition. Treatment options for acromioclavicular joint pathology may include physical therapy, anti-inflammatory medications, corticosteroid injections, or surgery in severe cases.

If the test result is negative, the healthcare professional should investigate other potential causes of shoulder pain. Additional clinical tests and examinations may be necessary to identify the underlying issue, ensuring a comprehensive approach to diagnosis and management.

How to use our Paxinos Test template

The Paxinos Test template is designed to help healthcare professionals accurately diagnose acromioclavicular joint pain. This template provides a clear and structured approach to performing and documenting the test, ensuring consistency and reliability in the results. Follow these steps to use the template effectively:

Step 1: Prepare the patient

Begin by instructing the patient to sit comfortably on an examination table or chair with their symptomatic arm resting by their side. Make sure the patient is relaxed and understands the procedure. Explain the test to gain cooperation and ensure they know what to expect.

Step 2: Position the examiner’s hands

Place your thumb under the posterolateral aspect of the acromion on the patient’s symptomatic side. Then, position your index and middle fingers of the same (or contralateral) hand superior to the mid-clavicle. This setup is crucial for applying the necessary pressure to elicit a response.

Step 3: Apply pressure

Apply pressure to the acromion in an anterosuperior direction using your thumb. Simultaneously, apply pressure in an inferior direction to the acromion, index, and mid-clavicle with your index and middle fingers. This maneuver is aimed at provoking any pain or discomfort from the acromioclavicular joint.

Step 4: Monitor the patient’s response

Observe the patient’s reaction to the applied pressure. A positive test is indicated by pain elicited or increased in the AC joint region. Record the patient’s pain response accurately in the results section of the template.

Step 5: Document the results

Use the template to document whether the test results are positive or negative. A positive test result suggests potential inflammation or irritation of the AC joint, while a negative result indicates no significant issues with the AC joint. Ensure all findings and observations are noted clearly.

Benefits of conducting this test

Conducting the Paxinos Test offers several significant benefits, especially in diagnosing AC joint pain.

Accurate diagnosis

The Paxinos Test helps accurately identify AC joint pain by replicating the specific stress that aggravates the joint, leading to precise diagnosis and treatment planning.

Efficient treatment planning

By pinpointing the source of shoulder pain, healthcare professionals can develop targeted treatment plans that address the patient's specific needs, improving recovery times and outcomes.

Non-invasive and cost-effective

The Paxinos Test is a simple, non-invasive procedure that can be conducted quickly without expensive equipment or imaging tests, making it a cost-effective option for patients and healthcare providers.

Treatments for acromioclavicular joint pain

Treatment options for AC joint pain depend on the severity and underlying cause.

Conservative treatments

Initial treatments often include rest, ice application, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Physical therapy exercises can strengthen the shoulder muscles and improve joint stability.

Injections

Corticosteroid injections can be administered to reduce inflammation and provide pain relief, particularly for patients who do not respond to initial conservative treatments.

Surgical intervention

In severe cases or when conservative treatments fail, surgical options such as AC joint reconstruction or arthroscopic surgery may be considered to repair or remove damaged tissue and restore joint function.