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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