Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability.
A recent study investigated the diagnostic accuracy of clinical tests for traumatic anterior shoulder instability, using magnetic resonance arthrography as a reference standard. They also aimed to develop a prediction model by combining accurate tests with aspects of patient characteristics and history detected in 168 participants, that might indicate the presence of the instability. The 6 clinical tests investigated were:
1. Apprehension test (90° of ABD and ER);
2. Relocation test (after positive Apprehension test, apply posterior force at humeral head);
3. Anterior release test (after Relocation test eases feelings of apprehension, release posterior pressure);
4. Anterior drawer test (in 80-120° of ABD, 0-20° of Flex, 0-30° of ER);
5. Load and shift test (in 90° scapular ABD, apply longitudinal humeral force, then shift humeral head anteriorly);
6. Hyperabduction test (therapist forearm exerts downward pressure on shoulder girdle while the arm is passively abducted).
The overall accuracy of the clinical tests, compared to the reference standard ranged from 80.5-86.4%, with the Anterior release test scoring best. The Relocation test was most sensitive (96.7%), while the Anterior drawer recorded the highest specificity (92.7%). Older age, previous history of shoulder dislocation, sudden onset of complaints and a positive result in the release test were important indicators for traumatic anterior shoulder instability. > From: Van Kampen et al., J Shoulder Elbow Surg (2013) (Epub ahead of print). All rights reserved to the Journal of Shoulder and Elbow Surgery Board of Trustees.
The Pubmed summary of the article can be found here.