Clinical use of the olecranon-manubrium percussion sign in shoulder trauma

Stephen L. Adams*, Paul R. Yarnold, James J. Mathews IV

*Corresponding author for this work

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

We conducted a study to assess the efficacy of the use of osteophony in the evaluation of shoulder trauma. Evaluation of the shoulder includes the physical examination and often a radiographic series. We studied the usefulness of the olecranon-manubrium percussion (OMP) test, a physical diagnostic procedure performed in shoulder trauma. The bell of the stethoscope is placed over the manubrium, both elbows are flexed at 90°, and the olecranon is percussed. In the normal examination with no disruption of bony conduction, both sides should produce a crisp equal sound. In the event of a dislocation or fracture with disruption of bony conduction, the affected side should be duller in pitch and intensity. We evaluated the utilization of the OMP test to assess its accuracy when used as a screening test for radiographs in conjunction with the physical examination and radiographic examination. Ninety-six patients were prospectively evaluated by the OMP test and also received radiographs. In those patients who had radiographic abnormalities, 40 of 47 (85.1%) had an abnormal OMP sign. In those patients without radiographic abnormalities, none had an abnormal OMP sign. In assessing anterior shoulder dislocations, 11 of 13 (84.6%) had an abnormal OMP sign (P < .02). After relocation, 100% had a normal OMP sign. Of those with clavicular fractures, nine of nine (100%) had abnormal OMP signs (P < .005). Of those with a fracture of the humerus, 16 of 20 (80%) revealed an abnormal OMP test (P < .01). The test was not significant in assessing acromio-clavicular joint abnormalities. Overall accuracy of the OMP sign based on two observers was 93%. In the series, the OMP test did not result in a false-positive error, but did result in a 15% false-negative error. Although the presence of a normal OMP sign does not negate the need for radiographic studies in patients with shoulder injury, the presence of an abnormal OMP sign suggests the need for appropriate radiographic studies. We conclude that the OMP sign is a helpful adjunct in the physical examination of shoulder injuries.

Original languageEnglish (US)
Pages (from-to)484-487
Number of pages4
JournalAnnals of Emergency Medicine
Volume17
Issue number5
DOIs
StatePublished - May 1988

Keywords

  • sign, olecranon-manubrium, shoulder
  • trauma, shoulder, olecranon-manubrium

ASJC Scopus subject areas

  • Emergency Medicine

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