A 26-year-old javelin thrower has deep anterior shoulder pain and clicking during the cocking phase of throwing. The O'Brien active compression test reproduces pain when the arm is flexed 90 degrees, adducted and internally rotated, relieved in external rotation. Which lesion is most likely?

• A AC joint osteoarthritis
• B Type II SLAP tear ✓
• C Subscapularis tear
• D Adhesive capsulitis

Explanation

The O'Brien test localises pain to the biceps-labral complex: pain on resisted forward flexion in internal rotation that eases in external rotation suggests a superior labral tear. In overhead athletes this is typically a type II SLAP tear extending into the long head of biceps anchor, caused by peel-back of the labrum during late cocking. AC joint pathology also gives a positive O'Brien test, but it produces top-of-shoulder pain rather than deep clicking during throwing.

Reference: DeLee and Drez's Orthopaedic Sports Medicine, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.