Paxinos Sign | Acromioclavicular Joint Pathology Assessment

Paxinos Sign is a common orthopedic test to assess for Acromioclavicular Joint Pathology. According to Walton et al. (2004) the Paxinos Sign has sensitivity of 79% and the specificity of 50% which in our opinion gives it a weak clinical value.

To conduct the tests the patient is in sitting position with the arm resting alongside the body. You’re going to stand behind the patient on the symptomatic side that you want to examine. Place your hand over the shoulder in a way that the thumb rests under the posterior lateral aspect of the acromion and the index and long fingers superiorly to the mid part of the clavicle. Then apply pressure to the acromion with the thumb in the anterosuperior direction and inferior directed pressure on the clavicle shaft with the other fingers.

The test is considered positive if the pain is felt in the region of the AC joint.

Other common orthopedic tests to assess for AC Joint Pathology are:

• Cross Body Adduction Test
• Active Compression Test of O’Brien
• AC Joint Line Tenderness
• AC Joint Resisted Extension Test
• AC Shear Test
• AC Joint Pain Cluster of Signs & Symptoms
• AC Joint Provocation Cluster by Krill
• AC Joint Provocation Cluster by Chronopoulos

Walton J, Mahajan S, Paxinos A, Marshall J, Bryant C, Shnier R, Quinn R, Murrell GA. Diagnostic values of tests for acromioclavicular joint pain. JBJS. 2004 Apr 1;86(4):807-12.

Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. The Physician and sportsmedicine. 2018 Jan 2;46(1):98-104.