AC Joint Line Tenderness | Acromioclavicular Joint Pathology

Palpation of the acromioclavicular (AC) joint for tenderness is a common orthopedic test to assess for AC joint pathology or sensitivity.

According to Walten et al. (2004), the Joint Line Tenderness assessment has a sensitivity of 96% and a low specificity of 10%, which you would think translates into a promising tool to exclude AC joint pathology in case of a negative test due to its high sensitivity.

But this is an excellent example where the Spin and Snout rule goes terribly wrong. The sensitivity and specificity combined result in a negative likelihood ratio of 0.4 which is far from great to really exclude a condition.

To conduct the tests the patient is in a sitting position with the arm resting alongside the body. Stand on the symptomatic side and palpate the joint line between the acromion and the clavicle to find it. Locate the broad bony acromion and then palpate along its rim anterio-medially until you reach the clavicle.

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

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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

• Cross Body Adduction Test
• Active Compression Test of O’Brien
• Paxino’s Sign
• 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.