A Modification of the Active Compression Test for the Shoulder Biceps-Labrum Complex

Abstract

The active compression test (O'Brien Sign) is widely used by physicians to aid in the diagnosis of biceps-labrum complex disease. This maneuver has been particularly criticized in the literature, however, with regard to interobserver reliability. Criticisms may in fact stem from inaccurate and inconsistent practice of the examination maneuver, stemming from both patient- and physician-related errors. In this Technical Note, we introduce an easy modification to the O'Brien Sign that limits such errors and improves test uniformity.

Fig 1

The patient stands facing the examiner. With the elbows in extension, both upper extremities are forward flexed to 90°, adducted to 10°-15°, and internally rotated so that the dorsum of the hands are opposed.

Fig 2

The examiner applies a uniform downward force simultaneously to both upper extremities at the level of the wrist as the patient resists to maintain arm position (step 1).

Fig 3

While maintaining 90° forward flexed position, the arms are fully supinated such that the palms are facing up and the ulnar surfaces of the hands are apposed. The examiner applies a simultaneous bilateral downward force as the patient resists (step 2).