Have you tried some A/C joint tapping to see if that would decrease the
pain. The O'Brian's test is a good test for differentiating between A/C and
biceps/labral damage... try it and see what you find.
Also, have you looked at the scapulothoracic and S/C joints for any
biomchanical abnormalites??
Henry***
>From: Frank Conijn <[log in to unmask]>
>Reply-To: - for physiotherapists in education and practice
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Fw: Post. rotation of clavicle
>Date: Fri, 8 Jun 2001 21:21:48 +0200
>
>Please ignore the last line....
>
>
>
>----- Original Message -----
>From: "Frank Conijn" <[log in to unmask]>
>To: "- for physiotherapists in education and practice"
><[log in to unmask]>
>Sent: vrijdag 8 juni 2001 21:18
>Subject: Re: Post. rotation of clavicle
>
>
>Dear Catherine,
>
>From the American Journal of Sports Medicine:
>
>--------------------------------------------------
>
>Volume 26, Number 5, September-October 1998
>
>The Active Compression Test: A New and Effective Test for Diagnosing Labral
>Tears and Acromioclavicular Joint Abnormality
>
>Stephen J. O'Brien, MD, Michael J. Pagnani, MD, Stephen Fealy, MD, Scott R.
>McGlynn, and Joseph B. Wilson
>
>From the Department of Sports Medicine and Shoulder Service, The Hospital
>For Special Surgery, New York, New York
>
>
>Labral tears and acromioclavicular joint abnormalities were differentiated
>on physical examination using a new diagnostic test. The standing patient
>forward flexed the arm to 90° with the elbow in full extension and then
>adducted the arm 10° to 15° medial to the sagittal plane of the body and
>internally rotated it so that the thumb pointed downward. The examiner,
>standing behind the patient, applied a uniform downward force to the arm.
>With the arm in the same position, the palm was then fully supinated and
>the
>maneuver was repeated. The test was considered positive if pain was
>elicited
>during the first maneuver, and was reduced or eliminated with the second.
>Pain localized to the acromioclavicular joint or "on top" was diagnostic of
>acromioclavicular joint abnormality, whereas pain or painful clicking
>described as "inside" the shoulder was considered indicative of labral
>abnormality. A prospective study was performed on 318 patients to determine
>the sensitivity, specificity, and positive and negative predictive values
>of
>the test. Fifty-three of 56 patients whose preoperative examinations
>indicated a labral tear had confirmed labral tears that were repaired at
>surgery. Fifty-five of 62 patients who had pain in the acromioclavicular
>joint and whose preoperative examinations indicated abnormalities in the
>joint had positive clinical, operative, or radiographic evidence of
>acromioclavicular injury. There were no false- negative results in either
>group.
>
>----------------------------------------------------------
>
>Note that the authors write that patients who had pain in the ACJ had
>positive clinical, operative OR radiographic evidence of AC injury.
>
>Is the rest of the Cyriax examination normal (I guess so, but I don't read
>it)?
>
>Hope this helps you out,
>Frank
>
>
>
>
>----- Original Message -----
>From: "Physiotherapy" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: vrijdag 8 juni 2001 20:09
>Subject: Post. rotation of clavicle
>
>
>I have a patient who came to me after falling off his snowmobile and
>struck the superior aspect of the shoulder girdle. His main complaint
>now is of pain along the length of the clavicle at 90 degrees
>glenohumeral flexion. The pain gets no worse as he performs full range
>flexion. Horizontal adduction causes minimal discomfort. X-rays,
>arthrogram all -ve. Movements that lead to posterior rotation of the
>clavicle (depression, retraction, medial rotation of humerus) cause the
>pain. Acromioclavicular joint is tender on palpation. Everything else
>seems fine including conoid and trapezoid ligaments. Suggestions for
>treatment would be much appreciated and what are the possibilities for
>injured structure? Thanks in anticipation Catherine
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