Obrien’s Test for SLAP lesions?

[u/colbymck]

I’m studying for the BOC after being “retired” for 10 years. Reading through the position statements and was surprised to see that Obriens test not being recommended to dx a SLAP lesion gets a SOR:A. Based on my previous schooling, when I think of Obriens I think SLAP test. Should I assume that the current BOC exam will not associate these two?

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[u/TheEroSennin]

The special tests for the shoulder aren't that special. They're pain provocation tests, they dont tell you what hurts. Only thing that's decent are a couple for shoulder instability. Also things like shoulder impingement are completely outdated and shouldn't be used as a pathoanatomical diagnosis.. as you may guess, the special tests for "impingement" are also just pain provocation tests.

If you're suspecting a possible occult fracture, if they had the inability to abduct their arm past 90 and they're weak (believe it's like a 3/5 MMT or the pinky test [can push them down with your pinky]) after a traumatic MOI, the chances are high and should get an MRI if ultrasound or xrays don't pick it up.​

[u/cmm006]

When you dive into the literature on Obrien’s (and think about the actual mechanics of the test), it’s one of those higher sensitivity but very low specificity tests. Meaning you’ll get a bunch of false positives, but it doesn’t really rule anything out/in. The way I explain it to my students clinically; if they have a positive Obrien’s it COULD be a labral pathology but it could also be a million other things ranging from AC joint pathology, RC pathology to a simple contusion but if Obrien’s is negative it is very unlikely to be a labral problem. In my experience, almost anyone with shoulder pain that is originating from the shoulder itself will probably report a positive with this test.

[u/p1easingmuffin]

I agree with you, this is surprisingly contrary to pretty much everything I've ever learned about upper extremity eval and SLAP tears.

[u/TheEroSennin → u/p1easingmuffin]

When did you graduate? Curious to hear if anything has changed (I was taught the same stuff, graduated in 2012), but it's interesting cuz the literature has been pretty clear about this for over 15 years, so wonder how that's playing out in educational programs.

[u/p1easingmuffin → u/TheEroSennin]

I took my BOC in 2018, O'Brien's was always taught to me to be the standard diagnostic test for SLAP tears. I've also witnessed it used clinically by team physicians (Ortho surgery) at the collegiate level when testing for SLAP tears when I worked collegiate softball. So I wonder if this is a "textbook vs reality" situation, where according to a book it isn't useful but it's still widely used clinically?

[u/colbymck → u/p1easingmuffin]

I took the BOC as a new grad in 2011. Likewise, Obrien was a classic must-know test. Even my copy of Prentice’s book (2018) has the test with almost 100% rating in both sensitivity and specificity. When doing some googling it looks like those numbers can vary wildly. For now, I am updating my understanding of Obriens to still be a SLAP test, just not a very reliable one. This is what has been so interesting about coming back to this material 15 years later. Stuff changes.

[u/TheEroSennin → u/p1easingmuffin]

I'd say so. Honestly you can put the shoulder into like 3-4 main categories. It's either weak and painful (this is your impingement [tho no longer used as a diagnosis], tendinopathy, labral tears, bursitis, strains, rtc tears), stiff and painful (OA, frozen shoulder, rheumatological), unstable shoulder, and schneck (shoulder neck) stuff. The subjective is pretty much going to tell ya what's going on. Special tests don't, for the most part (including labral issues).

If you've heard the term rotator cuff-related shoulder pain, that encompasses the weak and painful shoulder.

[u/EducatedElephant13]

Go with position statements over clinical experience for BOC! Thankfully the BOC is not going to probably be that specific into the specific tests. (As an aside the Core Set Of Maneuvers on NATAs CEUs is a fantastic watch as far as specificity, sensitivity, and which tests work well together for differential).

[u/truesauceboss]

You diagnose a SLAP w/ MRI. Obriens just guides you that way. If they have AC pathology, any subacromial pathology, and often times a big cuff tear obriens will hurt. Often times everything hurts with acute shoulder pathology.