THE ACTIVE COMPRESSION TEST - A NEW AND EFFECTIVE TEST FOR DIAGNOSINGLABRAL TEARS AND ACROMIOCLAVICULAR JOINT ABNORMALITY

Labral tears and acromioclavicular joint abnormalities were differenti ated on physical examination using a new diagnostic test. The standing patient forward flexed the arm to 90 degrees with the elbow in full e xtension and then adducted the arm 10 degrees to 15 degrees medial to the sagittal plane of the body and internally rotated it so that the t humb pointed downward. The examiner, standing behind the patient, appl ied a uniform downward force to the arm. With the arm in the same posi tion, the palm was then fully supinated and the maneuver was repeated. The test was considered positive if pain was elicited during the firs t maneuver, and was reduced or eliminated with the second. Pain locali zed to the acromioclavicular joint or ''on top'' was diagnostic of acr omioclavicular joint abnormality, whereas pain or painful clicking des cribed as ''inside'' the shoulder was considered indicative of labral abnormality. A prospective study was performed on 318 patients to dete rmine the sensitivity, specificity, and positive and negative predicti ve values of the test. Fifty-three of 56 patients whose preoperative e xaminations indicated a labral tear had confirmed labral tears that we re repaired at surgery. Fifty-five of 62 patients who had pain in the acromioclavicular joint and whose preoperative examinations indicated abnormalilties in the joint had positive clinical, operative, or radio graphic evidence of acromioclavicular injury. There were no false-nega tive results in either group.