Special Tests: Shoulder Instability (Apprehension) and Labrum Pathology

Special Tests Covered in this Lesson:

• Anterior Shoulder Laxity (Apprehension) Test Cluster
  • Apprehension Test (Included in "Apprehension Tests Video")
  • Jobe's Relocation Test (Included in the "Apprehension Tests Video")
• Brookbush Institute's SLAP Tear Test-item Cluster (Best-of Cluster)
  • Biceps Load 2
  • Jerk Test
  • Obrien's Active Compression Test
• Posterior Inferior Labral Lesion
  • Jerk Test
• Additional Tests (Note: Additional tests are not on the exam)
  • Speed's Test
  • Yergason's Test
  • Compression Rotation Test
  • Kim's Test

Shoulder instability, in particular anterior shoulder instability, may contribute to shoulder pain, dysfunction, and a decrease in sports performance. Further, instability can increase the risk of shoulder injuries, including repetitive strain, rotator cuff tear, ligament damage, labral pathology and shoulder dislocation. Significant instability (and joint capsule laxity) can even result in recurrent dislocations, and/or spontaneous partial dislocations. Clinical professionals (physical therapists, physical therapy assistants, chiropractors, occupational therapists, athletic trainers, etc.) should be aware of the signs and symptoms of instability and labral pathology, and the special tests that may aid in diagnosing and screening patients and clients. Often mild to moderate instability and labrum injury can be successfully treated with interventions and exercises intended to improve thoracic and lower cervical spine soft tissue and joint mobility, rotator cuff activaty, and scapular (shoulder blade) motion.

Instability and Labrum Pathology Tests:

The tests for instability are included in the clusters to test for glenoid labral pathology, so the development of an ideal labral pathology cluster will result in testing for both pathologies. The research investigating clusters for labral pathology tend to group tests that compress the labrum, tests for apprehension (instability), tests that resist shoulder flexion, and/or tests that load the biceps tendon (4, 6, 7, 9, 24, 30, 32). However, the currently available research fails to investigate clusters that combine the best tests from each of these categories. That is, most of the investigated clusters include tests that later studies demonstrated were of little diagnostic value. Compression tests are particularly inaccurate (relatively low specificity and sensitivity) (9, 14). Our recommendation for practice is to group the best apprehension test, best biceps tendon load test, best shoulder flexion test, and exclude the compression tests. Additionally a test is needed for posterior inferior labral pathology, and order needs to be considered for potential continuation to testing clusters for other pathologies. The result is a "best of" cluster with higher utility for practice. Of course, further research is needed to confirm that this cluster exhibits higher specificity, sensitivity, and predictive value.

Brookbush Institute Recommendation

Clusters and Flow: The order of these tests has been carefully considered for optimal efficiency. Starting with the apprehension tests allows for a positive or negative diagnosis of instability, followed by the Biceps Load 2 which is the most accurate test to use if "screening" for labral pathology, and the cluster ends with O'Brien's to allow for a quick "pivot" to the AC Joint Testing cluster if the pain is noted in or on the AC Joint.

Brookbush Institute's "Best of" Instability and Labral Pathology Cluster

• Apprehension Test
• Jobe's Relocation Test
• Biceps Load 2
• Jerk Test
• Obrien's Active Compression Test

For an Introduction to Special Tests:

• For an introduction to Special Tests including definitions of specific terminology, what special tests measure, accuracy (specificity, sensitivity, reliability, etc.), how we chose the tests in each special test course lessons, and best practice recommendations:
• Special Tests: Introduction

Courses covering Special Tests for the Shoulder Girdle

• Special Tests: Shoulder Impingement Syndrome (SIS)
• Special Tests: Rotator Cuff Pathology
• Special Tests: Acromioclavicular (AC) Joint Pathology
• Special Tests: Shoulder Instability (Apprehension) and Labrum Pathology