Paxinos Test (AC-Ledd)

The Paxinos Sign is used to identify pain originating from the acromioclavicular (AC) joint and to assess possible pathology such as AC joint osteoarthritis, ligament injury, or post-traumatic pain¹.

Test execution

Patient position

• The patient sits with the symptomatic arm relaxed at the side.

Procedure

1. The examiner places the thumb under the posterolateral aspect of the acromion.

2. The index and middle fingers are positioned over the midportion of the clavicle.

3. Pressure is applied simultaneously:

   • Thumb pushes anterosuperiorly against the acromion.

   • Fingers push inferiorly against the clavicle.

Interpretation

• Positive test: Pain or increased discomfort at the AC joint.

Diagnostic validity

Parameter	Value (%)
Sensitivity	79
Specificity	50
Positive Predictive Value (PPV)	61
Negative Predictive Value (NPV)	70
Positive Likelihood Ratio (+LR)	1.58
Negative Likelihood Ratio (–LR)	0.42

Clinical relevance

• A positive Paxinos Sign indicates likely AC joint dysfunction or irritation.

• Due to its low specificity, the test should not be used alone to establish diagnosis.

• It should be combined with other AC joint tests, such as:

  • Cross Body Adduction Test

  • O’Brien’s Active Compression Test

  • AC Resisted Extension Test

• Using a cluster of these tests improves diagnostic accuracy.

Conclusion

The Paxinos Sign is a simple and practical test for assessing AC joint-related pain.

• It shows moderate sensitivity but low specificity.

• Best applied as part of a test cluster for AC joint pathology.

References

1. Walton A, Mahajan S, Paxinos A, Marshall J, Bryant C, Shnier R, Quinn R, Murrell R. Diagnostic values of tests for acromioclavicular joint pain. J Bone Joint Surg. 2004; 86(4):807-812.

2. Paxinos Sign. Clinically Relevant Technologies. Accessed June 19, 2016 from https://www.youtube.com/watch?v=VwVMc9zsZAA