Paxino Test | AC joint instability

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?

In this test, the examiner places their hand over the top of the symptomatic shoulder with the thumb overlying posterior aspect of the acromion and the fingers resting over the anterior aspect of the distal clavicle. The examiner then squeezes the top of the shoulder which essentially forces the distal clavicle posteriorly and the acromion anteriorly.

[tele]

What does a positive Paxino Test mean?

Pain in the area of AC 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.