O’Brien Test | Active Compression Test | SLAP and AC Lesion Assessment

The O’Brien Test or Active Compression Test has a sensitivity of 67% and a specificity of 37% in the detection of SLAP lesions according to a meta-analysis by Hegedus et al. (2012). Therefore, the use of this test in clinical practice is at least questionable to diagnose SLAP lesions.
This test is also used in order to assess AC joint pathology. Krill et al. (2018) have evaluated this test regarding its ability to detect AC joint lesions and found a sensitivity of 14% and a specificity of 92%. For this reason, this test also has only a weak clinical utility in practice.

The performance of the Active Compression test is really similar to that of the Speed test. To perform the test, ask your patient to flex his shoulders to 90°, bring the shoulders into 10 degrees of adduction and the first testing position is with your patient’s shoulders in complete internal rotation. Then ask your patient to resist downward pressure.

Subsequently, ask your patient to fully laterally rotate his shoulders and resist downward pressure again.

This test is positive for SLAP lesion if the pain that is provoked during the first testing position is lessened or disappears in the second testing position. Green et al. (2008) have criticized the anatomical basis of this test, as the 2nd position produces a higher EMG activity for the biceps compared with the 1st testing position. In a SLAP lesion, you would therefore expect this test to be the other way round, as more biceps activity should in theory also provoke more pain at the origin of the long head of the biceps.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other tests, that perform better in the detection of SLAP lesions are the biceps load II test or the Yergason’s test.

Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British journal of sports medicine. 2012 Nov 1;46(14):964-78.

Green RA, Taylor NF, Mirkovic M, Perrott M. An evaluation of the anatomic basis of the O’Brien active compression test for superior labral anterior and posterior (SLAP) lesions. Journal of shoulder and elbow surgery. 2008 Jan 1;17(1):165-71.

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.