Let's learn more about the O'Brien Test for your shoulder pain.

When we have shoulder pain, we can't even do our daily tasks properly, right? Sometimes we can't lift our arms, it's hard to change clothes, or the pain is unbearable when we lift something. When you see a doctor like this, he will test you for various things to find the cause of your shoulder pain. That's right, the O'Brien test is a simple, yet very important test to understand exactly what's wrong with your shoulder.

Simply put, what is the O'Brien Test?

The O'Brien test is a simple physical test your doctor uses to find out what's causing your shoulder pain. It's not an X-ray or a blood test. It involves your doctor placing your arm in certain positions, applying a little pressure, and checking to see if you feel any pain. This is also called an 'active compression test.'

This test can provide clues about problems with two specific parts of the shoulder joint, namely:

1. A tear in the cartilage of the shoulder, especially a tear in a part called the labrum (labral tear).

2. A problem with the acromioclavicular (AC) joint , which is located at the top of the shoulder.

This test can be performed by various health professionals. For example:

• Orthopedists
• Physical therapists
• Athletic trainers
• Your family doctor (Primary care providers)

Why is this test done? What parts of the shoulder are examined?

To understand this, we first need to know a little about our shoulders. Think of our shoulders as a very complex, multi-directional machine. There are several major parts to it. The O'Brien test focuses on these two parts in particular.

1. AC joint (Acromioclavicular joint)

This is where our collarbone (clavicle) connects to the top of our shoulder bone (scapula). Simply put, this is the joint where two bones meet, which you can feel if you place your hand on the top of your shoulder. The O'Brien test helps to detect problems such as cartilage loss, joint separation, or a problem with this joint.

2. Labrum

Our shoulder joint is a 'ball-and-socket' joint. That is, the ball-like part of our upper arm bone (humerus) fits into a cup-like part of our shoulder bone (scapula). The labrum is a thick rubber-like piece of cartilage that surrounds this cup. It acts like a bumper, helping to keep the ball stable and not pop out of the cup.

Sometimes, this labrum can tear due to an accident or during sports. Especially when the upper part of this part is torn, it is called a SLAP tear (Superior Labrum, Anterior to Posterior). The O'Brien test can also give a clue as to whether this type of tear is present.

How to do this test? Step by step

This test is very simple. You don't need any special preparation for it. The doctor will ask you to sit or stand and follow these steps. It consists of two main parts.

First step (thumb down)

1. Raise your arm: Raise your arm on the side of your pain straight out in front of you, parallel to the floor (90 degrees). Keep your elbow completely straight.

2. Bring your hand inward: Now bring that raised hand slightly towards your body (about 10-15 degrees).

3. Rotate your hand: Next, rotate your hand inward, as if you were pouring water from a water bottle, with your thumb pointing down and the back of your hand facing your other hand. This is called ``pronation.''

4. Resist the pressure: Now the doctor will hold your wrist by the right side and press your hand down. What you need to do is resist the pressure, that is, try to push your hand up instead of letting it go down.

The doctor asks if you are feeling any pain in your shoulder at this time.

Second step (thumb up)

1. Change your hand position: Now turn your hand the other way. As if you were asking someone for something, your palm is facing up and your thumb is facing out. This position is called `(supination)`. Keep your hand still parallel to the ground, straight.

2. Resist the pressure again: The doctor will press your hand down again as before. You should try to hold your hand up against the pressure.

The doctor also asks how the pain is at this time.

What does a 'positive' result mean?

Now is the important part. This test is called 'positive' only if both of these conditions are met:

• You should feel pain in your shoulder in the first position (with your thumb pointing down).
• Also, in the second position (with the thumb turned up), the pain felt earlier should be significantly reduced or completely gone.

To understand this result more clearly, see the table below.

Is this test 100% accurate? What happens next?

This is something we all need to know. The O'Brien test is a very useful tool that can give you a clue about a shoulder problem. However, it is not a 100% accurate, definitive test. Sometimes, a person with a healthy shoulder can test positive for this test even if they have no problems.

The doctor comes to a final conclusion after considering the results of this examination, as well as the following:

• The details you provide: How the pain started, what time it was, what it felt like, etc.
• Other physical tests: Other tests that look at things like shoulder movement and strength.

Sometimes, your doctor may recommend several more tests to further confirm the diagnosis.

• X-ray, CT scan, or MRI: These can clearly see the bones, cartilage, and muscles inside the shoulder joint.
• Blood tests: Check to see if the pain is caused by other conditions, such as gout or rheumatoid arthritis.
• Shoulder arthroscopy: This is a minor surgery. A very small camera is inserted into the joint to see directly what the problem is inside.

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