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Reinterpretation of O'Brien test in posterior labral tears of the shoulder.

Owen JM, Boulter T, Walton M, Funk L, Mackenzie TA - Int J Shoulder Surg (2015 Jan-Mar)

Bottom Line: This may be in part due to difficulties in preoperative diagnosis.Multiple tests have been described for posterior labral pathology and none of these, on their own, have a high sensitivity rate.Posterior labral injuries can often be missed on magnetic resonance imaging scanning and also at surgery if not specifically looked for.

View Article: PubMed Central - PubMed

Affiliation: University of Manchester Medical School, Bridgewater Hospital, Manchester, MA15 5AT, UK.

ABSTRACT

Background: Injuries to the posterior labrum are less common and more difficult to diagnose compared to anterior labral pathology. This may be in part due to difficulties in preoperative diagnosis. Posterior labral injuries cause abnormal loading of the rotator cuff with subsequent weakness. Examination using the O'Briens test tightens the posterior capsule and posteriorly translates the humeral head, stressing the labrum resulting in pain and weakness.

Method: A retrospective study.

Results: Of 74 patients diagnosed with a posterior labral tear at arthroscopy 55 had subjective weakness on performing a O'Briens test, a sensitivity of 83% and a positive predictive value (PPV) of 90%.

Conclusion: Multiple tests have been described for posterior labral pathology and none of these, on their own, have a high sensitivity rate. Posterior labral injuries can often be missed on magnetic resonance imaging scanning and also at surgery if not specifically looked for. Using a sign of clinically demonstrated weakness when performing the O'Briens test, and hence reinterpretation of the test, is sensitive, with a high PPV for posterior labral pathology and can help guide further treatment.

No MeSH data available.


Related in: MedlinePlus

During O'Brien's test the posterior capsule is tight with anterior laxity and the line of pull of the deltoid during the test translates the humeral head posteriorly
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Figure 1: During O'Brien's test the posterior capsule is tight with anterior laxity and the line of pull of the deltoid during the test translates the humeral head posteriorly

Mentions: Between March 2010 and June 2013, 74 nonconsecutive patients who presented to the senior author (LF) were included in the study. All were prospectively examined, and their data entered into a database prior to undergoing arthroscopic examination and procedure. A retrospective case-controlled study was done on these data correlating the examination reference and the findings at shoulder arthroscopy. Data were collected with the consent of all patients and recorded using a patient management data system; patient confidentiality was maintained in all cases. For inclusion in the case controlled study criteria, requirements were: No prior surgery, over 16 years of age, and suspected posterior labral injury requiring arthroscopic stabilization. The entire sample received verification using the same reference standard, the O'Briens test, which was performed as part of their clinical examination prior to surgery. This test was conducted in a similar manner to that initially described by O'Brien.[7] The patient was asked to forward flex the affected arm 90° with the elbow in full extension. The patient then adducted the arm 10° to 15° medial to the sagittal plane of the body. The arm was internally rotated so that the thumb pointed downward. The examiner then applied a moderate downward force to the arm being resisted by the patient. The test was considered positive with objective weakness observed by the examiner when a moderate downward force on the arm resulted in loss of forward flexion from 90° [Figure 1]. The results of the O'Briens test were interpreted prior to the criterion standard of arthroscopic examination and then correlated to the intraoperative findings.


Reinterpretation of O'Brien test in posterior labral tears of the shoulder.

Owen JM, Boulter T, Walton M, Funk L, Mackenzie TA - Int J Shoulder Surg (2015 Jan-Mar)

During O'Brien's test the posterior capsule is tight with anterior laxity and the line of pull of the deltoid during the test translates the humeral head posteriorly
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325388&req=5

Figure 1: During O'Brien's test the posterior capsule is tight with anterior laxity and the line of pull of the deltoid during the test translates the humeral head posteriorly
Mentions: Between March 2010 and June 2013, 74 nonconsecutive patients who presented to the senior author (LF) were included in the study. All were prospectively examined, and their data entered into a database prior to undergoing arthroscopic examination and procedure. A retrospective case-controlled study was done on these data correlating the examination reference and the findings at shoulder arthroscopy. Data were collected with the consent of all patients and recorded using a patient management data system; patient confidentiality was maintained in all cases. For inclusion in the case controlled study criteria, requirements were: No prior surgery, over 16 years of age, and suspected posterior labral injury requiring arthroscopic stabilization. The entire sample received verification using the same reference standard, the O'Briens test, which was performed as part of their clinical examination prior to surgery. This test was conducted in a similar manner to that initially described by O'Brien.[7] The patient was asked to forward flex the affected arm 90° with the elbow in full extension. The patient then adducted the arm 10° to 15° medial to the sagittal plane of the body. The arm was internally rotated so that the thumb pointed downward. The examiner then applied a moderate downward force to the arm being resisted by the patient. The test was considered positive with objective weakness observed by the examiner when a moderate downward force on the arm resulted in loss of forward flexion from 90° [Figure 1]. The results of the O'Briens test were interpreted prior to the criterion standard of arthroscopic examination and then correlated to the intraoperative findings.

Bottom Line: This may be in part due to difficulties in preoperative diagnosis.Multiple tests have been described for posterior labral pathology and none of these, on their own, have a high sensitivity rate.Posterior labral injuries can often be missed on magnetic resonance imaging scanning and also at surgery if not specifically looked for.

View Article: PubMed Central - PubMed

Affiliation: University of Manchester Medical School, Bridgewater Hospital, Manchester, MA15 5AT, UK.

ABSTRACT

Background: Injuries to the posterior labrum are less common and more difficult to diagnose compared to anterior labral pathology. This may be in part due to difficulties in preoperative diagnosis. Posterior labral injuries cause abnormal loading of the rotator cuff with subsequent weakness. Examination using the O'Briens test tightens the posterior capsule and posteriorly translates the humeral head, stressing the labrum resulting in pain and weakness.

Method: A retrospective study.

Results: Of 74 patients diagnosed with a posterior labral tear at arthroscopy 55 had subjective weakness on performing a O'Briens test, a sensitivity of 83% and a positive predictive value (PPV) of 90%.

Conclusion: Multiple tests have been described for posterior labral pathology and none of these, on their own, have a high sensitivity rate. Posterior labral injuries can often be missed on magnetic resonance imaging scanning and also at surgery if not specifically looked for. Using a sign of clinically demonstrated weakness when performing the O'Briens test, and hence reinterpretation of the test, is sensitive, with a high PPV for posterior labral pathology and can help guide further treatment.

No MeSH data available.


Related in: MedlinePlus