Shoulder Assessment

AC Joint Line Tenderness | Acromioclavicular Joint Pathology

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AC Joint Line Tenderness

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

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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

References

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.

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