Clinical evaluation of acromioclavicular joint pathology: Sensitivity of a new test

Background: A prospective study was established to assess the sensitivity of the newly described Bell-van Riet (BvR) test for isolated AC pathology, and compare with 4 commonly used clinical tests. Materials and methods: The BvR test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Fifty-eight patients with isolated AC joint symptoms were assessed in random order with the BvR test and 4 other tests. A corticosteroid and local anaesthetic injection was administered into the AC joint space. The BvR test and 4 other tests were then repeated following the injection. After the injection, a symptom free clinical examination was used as a measure of truly positive tests. Results: The By R test showed a sensitivity of 98%. All 4 other tests were less sensitive. Conclusion: The BvR test is a highly sensitive test in patients presenting with isolated AC related symptoms, and demonstrates AC joint pathology better than other accepted tests. Level of evidence: Level HI, Diagnostic Study of Nonconsecutive Patients. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.