Anterior Shoulder Instability Cluster | Shoulder Assessment
The shoulder joint has a tremendous degree of mobility, which renders it prone to instability. While muscle forces control stability in mid-ranges of motion, clinical instability presents itself at end range of motion. The instability becomes apparent when a patient has apprehension or, fear of subluxation, at the end range of motion.
The shoulder apprehension test has a sensitivity of 65.6% and specificity of 95.4% according to Hegedus et al. (2012) and has a strong clinical value for including or confirming anterior instability. The shoulder relocation test has a sensitivity of 64.6% and a specificity of 90.2% according to the same authors.
Farber et al. (2006) combined both tests in one cluster and found a sensitivity of 81% and a specificity of 98%. Due to its high accuracy, this test cluster has a high clinical value in practice.
Apprehension Test
To conduct the test, the patient is in supine position with the side to be examined close to the edge of the bench. The patient’s shoulder is then brought into 90° of abduction. The patient is instructed to voice any apprehension or fear of subluxation to the examiner during the test. Subsequently, the examiner carefully brings the shoulder into more and more external rotation and is going to look for signs of apprehension by the patient.
In a positive test, the patient reports fear of luxation at greater ranges of external rotation.
Biomechanically it makes more sense to horizontally abduct the patient’s arm to have the head of the humerus glide anteriorly.
Relocation Test
The test is used when the patient has reported apprehension during the apprehension test. So the fear of subluxation when the patient’s arm is brought into 90° of abduction and added external rotation. There the examiner gives an anterior-to-posterior (AP) directed pressure at the humeral head.
The test is considered positive when the patient’s fear of luxation is reduced after the AP pressure is applied.
Other common tests to assess anterior glenohumeral joint instability are:
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
References
Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British journal of sports medicine. 2012 Nov 1;46(14):964-78.
