The Paxinos Test is commonly used to assess symptom provocation associated with the acromioclavicular joint. This article explains the test protocol, interpretation, diagnostic considerations, limitations and practical recording guidance for structured shoulder assessment.
Acromioclavicular (AC) joint pain commonly presents with:
superior shoulder discomfort
pain during pressing movements
pain during cross-body movement
tenderness over the AC joint
discomfort during overhead loading
The Paxinos Test is one of several shoulder orthopaedic assessments used to reproduce symptoms associated with the AC joint region through controlled manual compression.
The test is commonly used alongside:
AC joint palpation
Scarf Test
shoulder ROM assessment
loading assessment
symptom history
movement assessment
Although a positive Paxinos Test may increase suspicion of AC joint irritability in some populations, it should not be interpreted as a stand-alone diagnostic tool.
Primary purpose: Assess AC joint symptom provocation
Body region: Shoulder
Commonly associated with: AC joint irritation and superior shoulder pain
Positive finding: Reproduction of familiar AC joint symptoms
Negative finding: No meaningful AC joint symptom reproduction
Clinical role: Supports assessment reasoning but does not confirm pathology independently
Best interpreted with: Palpation findings, symptom history and broader shoulder assessment
The Paxinos Test is a shoulder orthopaedic assessment involving manual compression between the clavicle and acromion to stress the AC joint region.
The test is designed to:
reproduce AC joint symptoms
assess superior shoulder irritability
evaluate tolerance to local compression
support AC joint assessment reasoning
The assessment is most commonly used when AC joint involvement is suspected based on symptom location and loading behaviour.
The Paxinos Test may help:
reproduce familiar AC joint pain
assess superior shoulder symptom behaviour
support shoulder assessment clusters
guide further assessment
monitor symptom irritability over time
The test may be particularly relevant in:
contact athletes
gym-based populations
overhead athletes
clients with superior shoulder pain
clients reporting pain during pressing or cross-body movement
The Paxinos Test is intended to assess:
AC joint symptom provocation
superior shoulder compression sensitivity
local joint irritability
tolerance to AC joint loading
A positive finding may suggest increased sensitivity involving the AC joint region. However, the test does not confirm structural pathology independently.
The Paxinos Test may be useful for:
exercise professionals
sports performance settings
shoulder screening
movement assessment education
allied health assessment environments
shoulder monitoring
Consider using the Paxinos Test when a client reports:
superior shoulder pain
tenderness over the AC joint
pain during bench press or pressing movements
pain during cross-body movement
discomfort following shoulder contact injury
painful overhead loading
The test may become more meaningful when combined with:
AC joint palpation
Scarf Test findings
symptom history
shoulder loading assessment
movement assessment
Use caution when:
acute fracture is suspected
severe pain is present
symptoms are highly irritable
recent shoulder trauma occurred
post-operative restrictions exist
Stop testing if:
pain becomes excessive
neurological symptoms occur
the client requests cessation
Open assessment space
Documentation system
No specialised equipment is required.
The client may sit or stand comfortably in a relaxed position.
Stand beside the client while controlling the clavicle and scapular region.
Place one hand over the clavicle to stabilise it.
Position the thumb of the opposite hand beneath the posterolateral acromion.
Stabilise the clavicle.
Apply controlled upward pressure to the acromion.
Simultaneously apply downward pressure through the clavicle.
Compress the AC joint region gently.
Assess symptom response.
Ask the client to:
relax during testing
report familiar pain
describe symptom location
report any sharp or local discomfort
A positive finding may involve:
reproduction of familiar AC joint pain
local superior shoulder pain
tenderness around the AC joint region
A negative finding involves:
no meaningful symptom reproduction
absence of local AC joint discomfort
A positive Paxinos Test may increase suspicion of:
AC joint irritability
superior shoulder loading sensitivity
AC joint-related symptom provocation
The finding may become more meaningful when combined with:
local AC joint tenderness
positive cross-body adduction testing
painful pressing movements
symptom history consistent with AC joint loading
However, the test does not confirm AC joint pathology independently.
Pain during the test may also relate to:
general shoulder sensitivity
local soft tissue irritation
referred shoulder pain
movement apprehension
A negative finding may reduce suspicion of AC joint symptom provocation during manual compression.
However:
AC joint symptoms may still exist
symptoms may fluctuate depending on irritability
additional shoulder assessment may still be appropriate
There are currently no widely accepted normative values for the Paxinos Test because it is a symptom provocation assessment rather than a performance-based measurement test.
Interpretation is generally based on:
presence or absence of familiar pain
pain location
symptom severity
comparison with the opposite side
consistency across repeated testing
relationship to other shoulder findings
Practical comparison guidance may include:
comparison with baseline findings
symptom response over time
tolerance to shoulder loading
changes following activity modification or rehabilitation
Research investigating AC joint tests suggests:
isolated shoulder orthopaedic tests often have variable accuracy
clustered findings may improve assessment usefulness
symptom history and palpation remain important
Reliability may be influenced by:
compression consistency
hand placement
symptom irritability
examiner experience
client guarding
At the time of writing:
strong MDC, MCID and SEM values specific to the Paxinos Test remain limited
Published research investigating AC joint orthopaedic tests reports variable diagnostic accuracy depending on:
study design
reference standard
population
interpretation criteria
The Paxinos Test is generally considered more useful when combined with:
AC joint palpation
Scarf Test findings
symptom history
loading assessment
The test should not be interpreted as a stand-alone diagnostic assessment.
Common errors include:
excessive compression force
inconsistent hand placement
poor symptom clarification
overinterpreting pain alone
failure to compare findings with other assessments
Key limitations include:
variable diagnostic accuracy
overlap with other shoulder presentations
symptom provocation may occur in multiple conditions
limited stand-alone value
The Paxinos Test may help:
reproduce AC joint symptoms
guide further shoulder assessment
monitor symptom behaviour over time
contribute to structured shoulder documentation
support shoulder loading assessment
The test is often most useful alongside:
palpation
loading assessment
ROM assessment
movement assessment
additional AC joint tests
Record:
Test name: Paxinos Test
Side tested
Positive, negative or unclear finding
Pain location
Pain score
AC joint tenderness
Symptom severity
Compression response
Comparison side findings
Related shoulder findings
Retest date
Related shoulder assessments may include:
Scarf Test
O’Brien’s Test
AC Joint Palpation
Hawkins-Kennedy Test
Painful Arc
The Paxinos Test assesses symptom provocation associated with the AC joint during manual compression.
No. The test may contribute to assessment reasoning but does not confirm pathology independently.
A positive finding usually involves reproduction of familiar superior shoulder or AC joint pain.
No. Shoulder orthopaedic tests are generally more useful when interpreted alongside broader assessment findings.
Some discomfort may occur depending on compression force and local sensitivity, which is why symptom interpretation should consider the client’s full presentation.
The Paxinos Test assesses AC joint symptom provocation during manual compression.
A positive finding may increase suspicion of AC joint irritability.
The test does not confirm structural pathology independently.
Assessment findings are generally more useful when combined with broader shoulder examination results.
Consistent positioning and recording improve repeatability and monitoring quality.
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