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Value of Three Tests for Shoulder Instability

Arthroscopy has made it possible to see how well clinical tests used to diagnose shoulder problems measure up. Researchers can identify which tests are best to diagnose shoulder instability by comparing the final results of arthroscopy against the results of clinical tests.

In this study, three shoulder tests were done on 363 shoulder pain patients. Then shoulder arthroscopy was done to identify the exact problem. If the clinical test was positive during the test and the problem was seen with arthroscopy, the test was sensitive. If the test was negative and the arthroscope also showed nothing wrong, then the test was also specific.

Sensitivity and specificity was measured for anterior apprehension, relocation, and the anterior drawer test. The anterior apprehension test is positive when the patient has pain and is afraid the shoulder will dislocate. This occurs when the arm is placed in a position of shoulder abduction (away from the body) and external rotation (hand placed behind the head).

The relocation test is done with the patient lying down on his or her back (supine position). If the position causes pain or makes the patient anxious, then pressure is placed against the front of the shoulder. A positive relocation test occurs when the downward force against the shoulder relieves the sense that the shoulder is going to dislocate.

The final test (anterior drawer) is done in the same position as the relocation test (lying supine on a table with the shoulder just over the edge). The patient's arm is next to his or her body with the elbow bent 90 degrees.

References: Adam J. Farber, MD, et al. Clinical Assessment of Three Common Tests for Traumatic Anterior Shoulder Instability. In The Journal of Bone and Joint Surgery. July 2006. Vol. 88-A. No. 7. Pp. 1467-1474.

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