Introduction of a New Physical Examination Procedure for the Differentiation of Acromioclavicular Joint Lesions and Subacromial Impingement

Abstract

Objective: To present a new physical examination procedure that may assist in differentiating acromioclavicular joint lesions from subacromial impingement lesions.

Discussion: The acromioclavicular joint differential test is performed by applying downward pressure over the lateral one third of the clavicle while passively inducing slight adduction, external rotation, and forced forward flexion to the humerus while the patient is in the seated position. Although similar mechanisms have been described,the acromioclavicular joint differential test is a new, previously unreported examination procedure.

Conclusion: This article describes a new test to differentiate between acromioclavicular joint lesions and subacromial impingement. On the basis of its mechanism, the acromioclavicular joint differential test may provide the examiner with an additional tool in the differential diagnosis of acromioclavicular joint lesions and subacromial impingement in the patient with shoulder pain. Although this test has been used by the author in a clinical setting, validation data are not yet available. (J Manipulative Physiol Ther 1999;22:316-21)