Diagnostic value of physical tests for isolated chronic acromioclavicular lesions

Am J Sports Med. 2004 Apr-May;32(3):655-61. doi: 10.1177/0363546503261723.


Purpose: Chronic acromioclavicular joint lesions are a common source of pain and disability in the shoulder. The goal of this study was to evaluate diagnostic values of physical tests for isolated, chronic acromioclavicular joint lesions.

Study design: A retrospective case-control study.

Methods: Between 1994 and 2002, 35 patients underwent a distal clavicle excision for isolated acromioclavicular joint lesions. The results of 3 commonly used examinations for acromioclavicular joint lesions were calculated for sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy.

Results: The cross body adduction stress test showed the greatest sensitivity (77%), followed by the acromioclavicular resisted extension test (72%) and active compression test (41%). The active compression test had the greatest specificity (95%). All tests had a negative predictive value of greater than 94%, but the positive predictive value was less than 30% for all tests. The active compression test had the highest overall accuracy (92%), followed by the acromioclavicular resisted extension test (84%) and the cross arm adduction stress test (79%). Combinations of the tests increased the diagnostic values for chronic acromioclavicular joint lesions.

Conclusions: These tests have utility in evaluating patients with acromioclavicular joint pathologic lesions, and a combination of these physical tests is more helpful than isolated tests.

MeSH terms

  • Acromioclavicular Joint / physiopathology*
  • Adult
  • Case-Control Studies
  • Diagnosis, Differential
  • Female
  • Humans
  • Joint Diseases / diagnosis*
  • Male
  • Middle Aged
  • Physical Examination / methods*
  • Predictive Value of Tests
  • Retrospective Studies
  • Sensitivity and Specificity
  • Shoulder Pain / diagnosis*