Execution
- 1Position the patient standing with the shoulder flexed to 90° and elbow extended.
- 2Horizontally adduct the arm approximately 10° to 15° and internally rotates the shoulder with the thumb down.
- 3Apply a downward eccentric force that the patient resists.
- 4Repeat the manoeuvre with the forearm supinated and palm facing upward.
- 5Record whether pain is localized over the AC joint or deep inside the shoulder.
Positive outcome
For AC-joint interpretation, pain localized over the acromioclavicular joint in the thumb-down position is positive, especially if it decreases in the palm-up position. Deep intra-articular pain should be considered under labral / SLAP interpretation instead.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Chronopoulos et al. (2004) | NA | 72 | 95 | 14.4 | 0.29 |
| Walton et al. (2004) | NA | 41 | 95 | 8.2 | 0.62 |
CommentThe same manoeuvre appears in SLAP testing, but AC interpretation depends on precise pain location. Chronopoulos reported strong rule-in values in chronic isolated AC lesions; Walton found more modest performance. Do not score deep shoulder pain as AC-positive.
High Clinical Value