DIAGNOSTIC VALUE OF PHYSICAL TESTS IN ACROMIOCLAVICULAR JOINT PATHOLOGY

Abstract

Acromioclavicular (AC) joint arthritis is a frequent shoulder condition, which requires distal clavicle excision (DCE). While acromioclavicular (AC) joint conditions are common, no previous study has determined the clinical significance of physical findings for AC joint conditions upon physical examination of the shoulder. PURPOSE The purpose of this study is to evaluate the diagnostic value of the most frequently used examination tests including AC local joint injection in-patients with AC joint pathology. METHODS This prospective, non-randomized study included 737 patients with shoulder pain. All patients underwent a thorough clinical evaluation which included examination for local AC joint tenderness, the cross body adduction stress test, the AC joint extension test and the active compression test (a.k.a. O'Brien's test). 42 patients with positive at least one test were the study group while 580 patients were the control group. Injection of AC joint performed in 35 patients. All of them underwent surgery (arthroscopy) and final diagnosis was given after arthroscopic evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA), evaluated for each of the above tests. RESULTS 42 patients with AC joint pathology underwent distal clavicle excision (DCE). Local joint tenderness had the best sensitivity (91%) and the best NPV (99%). Active compression test had the lowest sensitivity (54%) and the best specificity (95%) and diagnostic accuracy (92%). Each test had NPV over (96%). CONCLUSIONS This study is the first to critically evaluate the clinical significance of these tests. Each of the above examination tests has some value in assessing AC joint pathology. Local tenderness remains one of the best diagnostic signs for AC joint pathology and should be performed when evaluated the AC joint. This information is helpful for physicians when assessing the AC joint pathology.