|
|
Re: painful shoulder
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
Re: painful shoulder - March 10, 2005 2:46:00 PM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Greg,
If you only had a great change up, you might be going before congress right now. You know, to discuss the juice.
...Or, posting on Baseballedge instead of rehabedge.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: painful shoulder - March 10, 2005 8:04:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Steve,
O'Brien, S. J., M. J. Pagnani, et al. (1998). “The active compression test: a new and
effective test for diagnosing labral tears and acromioclavicular joint abnormality.” American
Journal of Sports Medicine 26(5): 610-3.
If you can't get the article, it goes something like this: 318 patients, Reference Standard was shoulder surgery, Sensitivity of 1.0 (Wow) and Spec .985 (another Wow). Positive Liklihood ratio (+LR) of 66.7
This is one of those good tests, which Jon Newman likes to say, to have in your "tool box". :)
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: painful shoulder - March 11, 2005 5:30:00 AM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Alex,
I can't get the article, but thats phenomenal sensitivity/specificity - how were they performing the test? I have an idea but what were the particulars?
Thanks,
Steve
|
|
|
|
|
Re: painful shoulder - March 11, 2005 6:29:00 AM
|
|
|
JLS_PT_OCS
Posts: 1684
Joined: January 30, 2005
From: USA
Status: offline
|
You flex the involved arm to 90 in sagittal plane, then horizontally adduct arm 10-15 degrees.
Internally rotate until thumb is down a la empty can type position.
Resist flexion isometrically, note any pain.
Then rotate so palm is up (ER at GH joint) and repeat, note pain.
The test is positive for SLAP if there is pain during IR portion of test, but not ER portion of test.
Supposedly the ER allows the LH of biceps tendon to stabilize the humerus and prevent pressing against the torn labrum.
If pain is in both postions, Obrien said it was more likely an ACJ issue (if pain at superior shoulder).
Clinically, this test is real nice for your "impingement" people who don't progress with rehab. If I can't get anywhere with them after a good course of rehab, and Obrien is positive, I refer to Ortho for consideration of surgery.
Ironically, this test was named by Obrien the "Active Compression Test" perhaps in an attempt to stop naming tests by people and start naming them sensibly. However, we now all refer to this as the "OBrien Test" myself included. Poor Dr Obrien must find that funny...
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
|
|
|
|
|
Re: painful shoulder - March 11, 2005 7:35:00 AM
|
|
|
Jon Newman
Posts: 1708
Joined: April 24, 2004
From: Amherst, WI
Status: online
|
Hi Alex,
Thanks for the reference. As you've noted I'm often on the search for diagnostic tests. I'm trying to sort out the importance of this study (there is a free link to the full text within the link I'm providing.)
[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12435646]link[/URL]
jon
My mistake. There is no free link.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: painful shoulder - March 11, 2005 8:29:00 AM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
Jon and Jason,
I seem to remember reading Jon's posted study and this is where I got the idea that the test was not that accurate. Thanks Jason, for the detailed description, that is how I perform the test but was always curious as to why the ER position was not as painful in a positive test.
Steve
|
|
|
|
|
Re: painful shoulder - March 11, 2005 10:43:00 AM
|
|
|
chiroortho
Posts: 655
Joined: February 18, 2004
Status: offline
|
[QUOTE]If you only had a great change up, you might be going before congress right now. You know, to discuss the juice.[/QUOTE]LOL. Bonds is funny isn't he...'it was just some creme for sore muscles, really! I didn't know it was 99% methandriol, really, you have to believe me.'
_____________________________
Greg Priest, DC, DABCO
|
|
|
|
|
Re: painful shoulder - March 11, 2005 2:42:00 PM
|
|
|
Synergy
Posts: 592
Joined: March 11, 2004
From: Texas
Status: offline
|
There's a great article in this months JOSPT that is somewhat in line with this thread.
[URL=http://www.jospt.org/members/fulltext/2005/february/February2005-RR-Lewis.pdf]Subacromial Impingement Syndrome: The Effect of Changing Posture on Shoulder Range of Movement[/URL]
_____________________________
Chris Adams, PT, MPT
|
|
|
|
|
Re: painful shoulder - March 12, 2005 2:06:00 AM
|
|
|
Jon Newman
Posts: 1708
Joined: April 24, 2004
From: Amherst, WI
Status: online
|
In the spirit of EBM I think it would be interesing to compare and contrast the two articles related to the active compression test as they seem to give vastly different conclusions. Which one is the best available evidence? I don't currently have the full text of the articles but I'm working on it. If someone has access to them and wants to take a shot at it, I think it would be helpful to all.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: painful shoulder - March 12, 2005 5:20:00 AM
|
|
|
kjhsjly
Posts: 15
Joined: September 17, 2001
Status: offline
|
anyone know the frequency of false positives on the Obrien? (active compression test)and ways to
prevent/minimize them??
|
|
|
|
|
Re: painful shoulder - March 12, 2005 5:26:00 AM
|
|
|
kjhsjly
Posts: 15
Joined: September 17, 2001
Status: offline
|
is it probable for the obriens to be positive w/a
simple impingement/inflammation problem
|
|
|
|
|
Re: painful shoulder - March 12, 2005 11:42:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
Just to throw in a bit of a clanger, guys...
I have just tried the test as mentioned above on my (R)shoulder and in IR, I felt quite significant discomfort around the joint. ER (which releases a certain amount of neural tension) eased it at once.
My (R) shoulder has full function and normal ROM.
Thoughts?
Nari
|
|
|
|
|
Re: painful shoulder - March 13, 2005 5:23:00 AM
|
|
|
eam
Posts: 292
Joined: February 5, 2004
From: New York, NY 10028
Status: offline
|
THe article on the Active compression test/O'Briens is American Journal of Sports Medicine 26:610-613
1998.
"The Active Compression Test: A new and effective test for diagnosing labral tears and AC joint abnormality"-O'Brien, Pagnani et al.
I have it if anybody wants a copy.
The results from their study showed 3 false positives (out of 56 pts) One had a reverse Hill-Sachs lesion, one had a hypermobile biceps tendon with multi-dir laxity and biceps tendonitis and the third one had an anterior instability without a discrete labral tear. No false negs.
Nari-
I also did this test on myself and was positive in both directions!
Erica
|
|
|
|
|
Re: painful shoulder - March 13, 2005 10:09:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
When I perform this test (Active Compression) I am looking for reproduction of THEIR pain (ie the pain that brought them into your clinic), not just vague shoulder pain. If my clinical suspicion is high for a labral tear there should be 1) a clear mechanism of injury along with 2) exact reproduction of their shoulder complaint with the Active Compression test. If they have pain with both positions then this would not be a positive test. On the positive Active Compression's that I have seen it is blatantly obvious when you put them into the shoulder internal rotation position. A vague reproduction of pain, to me, would not be a positive.
On a side note; pain over the AC joint in the palm up position along with no pain in the internally rotated position is a good sign that the pain may be coming from the AC.
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: painful shoulder - March 20, 2005 9:10:00 AM
|
|
|
kjhsjly
Posts: 15
Joined: September 17, 2001
Status: offline
|
Hey guys. Had my cortisone shot Friday. Pain is still present. have a new doctor who believes its most likely a labral tear. will finish out 3 more weeks of therapy then an MRI with arthrogram and referral to shoulder specialist. any views on surgical vs. nonsurgical treatment? (looking to start a family soon, want to be able to pick up and carry my child without this pain)
|
|
|
|
|
Re: painful shoulder - March 20, 2005 10:57:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
So you're going to do fricken more than 7 weeks of PT and it isn't helping... great medical system we have, huh? Can I ask a really stupid question.... I will... The therapist that is treating you - why does your therapist continue to treat when no results are occurring?
Personally, if the surgeon has done lots of the procedures and the procedure would pretty much be able to be performed arthroscopically, I'd go for it. I'd qualify my opinion and mention that if the above tests are positive or elicit your complaint of pain along with another test which I don't know the name of (supine, shoulder kind of abducted/flexed and someone applies a force longitudinally into the joint and combined with that compression scours the joint like the hip joint). Heck, ask the ortho the probability or outcome without surgery and the time period to reach that outcome vs the surgical option.
|
|
|
|
|
Re: painful shoulder - March 20, 2005 11:07:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
SJ
I have often wondered why patients keep going and PTs keep treating when there are no changes or positive outcomes....
Why?
Nari
|
|
|
|
|
Re: painful shoulder - March 20, 2005 5:54:00 PM
|
|
|
jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline
|
They are probably told that over time, there will be changes and believe the longer they stay with a program, they better of they will get. PT's should be referring those patients back to the MD's if their is no changes seen since the initial evaluation.
JMA
|
|
|
|
|
Re: painful shoulder - March 20, 2005 10:40:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
kjhsjly,
I think the degree of the surgery might depend on how large a labral tear that you might have. Most that I have seen are repaired arthroscopically and the rehab for these is not too bad. I have also seen procedures done where they use small tacks to repair the labrum, in my experience the rehab for this type of procedure is a little more involved.
I would agree that you are probably wasting your time with 3 more weeks of PT. The MRI may even be overkill. If you have a positive Obriens/Active compression then you have a high probabilty of having the labral injury and should go straight to the ortho surgeon/surgery especially if several months of PT have already not been successful (at least that is what we would do in the military-although these are just my views not necessarily those of the entire military or department of defense :) ). That is the beauty of a good orthopaedic special test, in some cases it is more accurate than MRI. In fact in the Obrien study the gold standard was surgery (actual visual inspection of the labrum) and it was shown to have very high specificity. Good luck and let us know what the MRI shows.
Alex
_____________________________
Alex Brenner, PT, MPT, OCS
|
|
|
|
|
Re: painful shoulder - March 21, 2005 2:15:00 AM
|
|
|
SJBird55
Posts: 2438
Joined: May 10, 2004
From: Michigan
Status: offline
|
Nari, I wonder the same thing myself. jma... maybe, or is it because we have this little piece of paper signed by a doctor stating the person needs physical therapy? Or is there an unwritten rule in physical therapy departments that says that physical therapists should not use their brains to actually determine whether a person requires physical therapy or not? Or do physical therapists have a very difficult time actually saying, "I'm not the answer."
jma... I challenge that even after the first appointment, if physical therapy isn't going to give the desired results, there is no reason to even start! I remember a patient I had with a kind of similar complaint. I did that test you all have mentioned, plus one that has a high specificity (can't remember the name though). Anyways... didn't treat her - sent her back to MD. He put me in the hot seat and had me provide the proof and rationale for not attempting physical therapy. He even asked for the literature in which I was basing my decision. He ended up sending her on and she had surgery 2 or 3 weeks later.
It might be a personality thing too... I don't know. I know I've had my share of "discussions" with physicians on the topic of why physical therapy is inappropriate for a specific patient. I've found that as long as I had a strong rationale for my decision-making process, the physician learned and I gained just a smidgen of respect.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.188
|
Printable Version
