Concurrent Criterion-Related Validity of Acromioclavicular Joint Physical Examination Tests: A Systematic Review

Abstract

This article systematically reviews the available research on concurrent criterionrelated validity of physical examination tests for the diagnosis of acromioclavicular joint (ACJ) dysfunction. A literature search yielded four research studies on the topic of concurrent criterion-related validity of physical examination tests of the ACJ. These studies had various methodological shortcomings. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) criteria yielded scores from 1/22 to 16/22. All studies examined pain provocation tests only. The currently available best research evidence supports the inclusion of a number of tests with a specific interpretation in a physical examination format for the diagnosis of painful ACJ dysfunction. A negative finding on the cross-body adduction test, tenderness on palpation of the ACJ, and the Paxinos sign may serve to rule out a painful ACJ dysfunction. A positive finding on the active compression test, the cross-body adduction test, and the acromioclavicular resisted extension test may serve to rule in a painful ACJ dysfunction. A positive finding on all three tests for the cross-body adduction, active compression, and resisted acromioclavicular extension may be relevant when the physical therapist is considering a medical-surgical referral and associated higher-risk interventions. This review indicates that future research is required 1) to evaluate the diagnostic utility of the gold standard tests used in the studies retrieved; 2) to examine the reliability and concurrent criterion-related validity (with validated gold standard tests) of these and other physical tests and history items commonly used in the diagnosis of ACJ lesions, both isolated and in the form of multi-test regimens; and 3) to study predictive validity of findings on tests and multi-test regimens for ACJ dysfunction coupled to outcomes with diagnosis-specific (orthopedic manual) physical therapy, medical, and surgical interventions.