What Are Indications for O'Brien Testing?

As a physiotherapist, your ability to accurately diagnose shoulder injuries is crucial for providing effective treatment. The O’Brien Test, also known as the Active Compression Test, is an essential diagnostic tool for evaluating shoulder injuries, particularly labral tears and AC joint pathologies. This blog outlines the indications for O'Brien Testing, presented in a PDF-style note format for quick reference. For a detailed breakdown, you can also explore our guide on Speed's Test.
What is the O’Brien Test?
The O’Brien Test is a clinical examination designed to evaluate shoulder integrity, focusing on the glenoid labrum and acromioclavicular (AC) joint. The test identifies pain or discomfort caused by specific shoulder pathologies, helping to refine your diagnosis and treatment plans.

Purpose of the Test
Detects superior labral tears (SLAP lesions).
Identifies AC joint injuries.
Assists in diagnosing subtle shoulder instability or dysfunction.
How is the O’Brien Test Performed?
To perform the O'Brien Test, follow these steps:
Patient Positioning
The patient sits or stands with their shoulder flexed to 90 degrees.
The arm is adducted 10–15 degrees across the body, with the elbow fully extended.
Test Execution
The patient internally rotates their arm (thumb pointing downward). The therapist applies downward resistance.
The process is repeated with the arm externally rotated (palm up).
Positive Test
Pain or clicking during internal rotation that reduces with external rotation suggests a SLAP lesion.
Pain localized to the AC joint points to AC joint pathology.
Indications for O'Brien Testing
The O’Brien Test is indicated in cases where patients present with the following:

1. Shoulder Pain After Trauma Falling onto an outstretched arm or direct impact to the shoulder. Symptoms of catching or grinding in the shoulder joint.
2. Suspected SLAP Lesions Pain during overhead movements, especially in athletes. Complaints of deep, non-specific shoulder pain.
3. AC Joint Pathology Pain localized to the top of the shoulder. Worsened pain during horizontal adduction or when carrying heavy loads.
4. Recurrent Shoulder Instability History of shoulder dislocations or subluxations. Difficulty performing movements requiring stability (e.g., push-ups or lifting).
5. Overuse Injuries Pain arising from repetitive overhead activities, such as in swimmers, throwers, or gym enthusiasts. Clinical Interpretation of O’Brien Test Results Positive Results SLAP Lesion: Pain deep in the shoulder during internal rotation, alleviated by external rotation. AC Joint Pathology: Localized pain over the AC joint during both internal and external rotation. Negative Results If no pain or discomfort is elicited, it reduces the likelihood of labral tears or AC joint pathology, pointing to other possible diagnoses. Advantages of the O’Brien Test High Sensitivity: Reliable in identifying SLAP lesions. Simplicity: Easy to perform in a clinic without requiring special equipment. Versatility: Provides insight into both labral and AC joint conditions. Limitations of the O’Brien Test While the O’Brien Test is widely used, it has limitations: Subjectivity: Relies on patient-reported pain, which can vary. False Positives: May mimic symptoms of other conditions, such as rotator cuff injuries. Operator Dependency: Requires skilled technique to avoid misinterpretation of results. Complementary Tests for Greater Accuracy To improve diagnostic precision, the O’Brien Test is often combined with: Speed’s Test: To assess biceps tendon involvement. Crank Test: For additional evaluation of labral tears. Neer’s Impingement Test: To rule out rotator cuff impingement. For a comprehensive guide on Speed’s Test, refer to this blog. Free PDF Notes on O’Brien Testing For quick, accessible learning, we’ve compiled detailed notes on O’Brien Testing in PDF format. These notes are formatted like clinical handouts to support physiotherapists during practice. Download the Free PDF Notes Here Practical Tips for Physiotherapists Ensure clear instructions to the patient to avoid compensatory movements. Use both arms for comparison during the test. Document specific findings such as pain localization and movement quality to enhance clinical records. How to Incorporate O’Brien Test in Clinical Practice During Initial Assessment Utilize the test to narrow down differential diagnoses for shoulder pain. In Rehabilitation Progress Reassess using the test to monitor improvement or identify persistent issues. For Athletic Populations Apply during preseason screenings to detect early signs of shoulder dysfunction. Boost Your Knowledge with Physiotherapy CPD Courses Mastering tests like the O’Brien Test is just one step in advancing your clinical skills. To become an expert in shoulder assessments and treatments, explore advanced physiotherapy CPD courses like Shoulder Arthroplasty Physical Therapy. This course provides practical insights into managing complex shoulder cases with evidence-based strategies. Learn more about this course here. Conclusion The O’Brien Test is a fundamental tool in diagnosing SLAP lesions and AC joint pathologies. Its simplicity and effectiveness make it a go-to test for physiotherapists working with shoulder injuries. However, using it alongside other assessments ensures better diagnostic accuracy. If you’re looking to enhance your clinical expertise, consider enrolling in physiotherapy CPD courses. From free CPD physiotherapy courses to specialized physio CPD courses, there’s no better way to stay updated with the latest advancements in your field. Explore CPD courses for physiotherapists to build your skills and provide exceptional care.