Purpose of O’Brien’s Active Compression Test: To detect superior glenoid labral lesions and/or type 2 superior labrum anterior and posterior (SLAP) lesions (which is fraying of the superior glenoid labrum along with detachment of the biceps anchor) on the shoulder joint (1-3).

Patient position: Standing position, with affected arm in forward flexion at 90 degrees and slight adduction at 10-15 degrees towards the midline of the body, and elbow in full extension (1).

Examiner position: Standing beside/behind the patient, on the side of the affected arm (1).

Procedure:

Ask the patient to internally rotate the arm to have the thumb pointing towards the floor. Apply a uniform downward force on the distal end of the affected arm and ask the patient to resist the force. Repeat this test with patient’s arm externally rotated, and palm facing the ceiling (1).

Outcome:

The test is positive for labral lesions if the patient reports pain “deep inside” the shoulder joint with or without a click during the first step, and reports reduced or no pain during the second step i.e., the patient reports pain while having the affected arm internally rotated with the thumb pointing towards the floor, but reports reduced or no pain while having the arm externally rotated (1).

The test is positive for acromioclavicular joint abnormality if the patient reports pain localized to the acromioclavicular joint or “on top” of the shoulder joint (1).

Modification [to standardize arm adduction and maximal internal rotation] (4):

Patient position: Standing, with both arms in forward flexion at 90 degrees such that the dorsum of hands meet at the midline in front of the patient.

Examiner position: Standing in front of the patient.

Procedure: Apply a uniform downward force on both arms simultaneously.

The outcome/interpretation of this modified test is not different from the original test (1, 4). 

References:

1.        O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. The American journal of sports medicine. 1998;26(5):610-3.

2.        Keener JD, Brophy RH. Superior labral tears of the shoulder: pathogenesis, evaluation, and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2009;17(10):627-37.

3.        Kibler WB, Sciascia A. Current Practice for the Diagnosis of a SLAP Lesion: Systematic Review and Physician Survey. Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2015;31(12):2456-69.

4.        Urch E, Taylor SA, Zitkovsky H, O’Brien SJ, Dines JS, Dines DM. A Modification of the Active Compression Test for the Shoulder Biceps-Labrum Complex. Arthroscopy techniques. 2017;6(3):e859-e62.