Paxino Test Overview

The Paxino test can be a useful method to help solidify the diagnosis of occult AC joint instability or degeneration. It was first described by Walton et al. in 2004 .

How do you perform the Paxino Test?

The patient is seated with the test arm relaxed at the side. The examiner stands beside the test arm and places one hand over the shoulder so that the thumb is under the posterolateral aspect of the acromion and the index and long fingers of the same hand (the fingers of the opposite hand may also be used instead) over the middle part of the clavicle on the same side. The examiner then applies pressure to the acromion with the thumb anterosuperiorly while applying an inferior directed counterforce to the clavicle with the fingers.

What does a positive Paxino Test mean?

Pain in the area of acromioclavicular joint with this technique is considered a positive test and may indicate joint degeneration.

See Also: Ac Joint Arthritis

Accuracy

The original investigators calculated a sensitivity of 82 % and a specificity of 50 %; however, the presence of a positive bone scan significantly increased the post-test probability of AC joint-related pain. Yelland obtained similar results when bone scans were used to help solidify the diagnosis.

Another study found that the optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O’Brien’s Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O’Brien’s Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35).

See Also:

• Hawkins Kennedy Test
• O’Brien’s Test

Note

A potential variation of this test involves the clinician using the heels of their clasped hands to squeeze the clavicle posteriorly and the scapular spine anteriorly. Although no studies have evaluated this modified technique, we suspect that the sensitivity and specificity values are similar to those for the Paxino’s test which requires ancillary maneuvers to confirm the suspected diagnosis.

References

1. Walton J, Mahajan S, Paxinos A, Marshall J, Bryant C, Shnier R, Quinn R, Murrell GA. Diagnostic values of tests for acromioclavicular joint pain. J Bone Joint Surg Am. 2004 Apr;86(4):807-12. doi: 10.2106/00004623-200404000-00021. PMID: 15069148.
2. Yelland M. A positive result on both the Paxinos test and bone scan ruled in a diagnosis of acromioclavicular joint pain. Evid Based Med. 2005;10(1):27.
3. Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. Phys Sportsmed. 2018 Feb;46(1):98-104. doi: 10.1080/00913847.2018.1413920. Epub 2017 Dec 13. PMID: 29210329; PMCID: PMC6396285.