Instability Tests

Video Transcription

0:00 To assess for instability, you can examine the patient in the supine or sitting position. I prefer the sitting position. The anterior apprehension test involves an anterior translational force while bringing the arm into abduction and external rotation. The Jobe Relaction test applies a posterior force which stabilizes the joint and allows further movement in that direction. The anterior translation test is assessed by stabilizing the shoulder with one hand while applying an anterior force on the humeral head with the other. This can be assessed on three grades. The anterior translation test may be more easily preformed in the supine position as demonstrated. The sulcer sign is demonstrated here by applying a downward force on the humorous. In the case of the unstable shoulder, the increase in translation will increase the negative pressure in the joint, causing a concave effect in the shape of the deltoid.
1:10 Although the majority of shoulder instability is anterior/inferior, it is important to test for multi-direction instability with an inferior applied force with the shoulder in abduction and for posterior instability, place the arm in forward flexion and abduction with a backward applied force. To complete the examination, we must assess for hyperlaxity. This is done by assessing thumb abduction, as demonstrated, scoring one point for each side. Finger hyperextension, again scoring one point for each side, elbow hyperextension, as demonstrated here, with a point given for each side, knee hyperextension, as demonstrated, again scoring one point for each side, and finally asking the patient with the legs straight to touch the floor with the palm of their hands as demonstrated. This is a further point making the total nine.

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