0:04 This is Brent of the Brookbush 0:05 Institute, and in this video we're going to 0:07 go over special, or orthopedic tests 0:09 for the shoulder. In this video, we're 0:11 going to go over our instability, or 0:13 anterior laxity tests. That includes our 0:16 apprehension test, our lift-off or 0:19 surprise test, our Jobe's relocation test 0:22 and our modified Jobe's relocation test. I 0:25 think you'll find that all of these 0:26 tests are very, very similar to one 0:29 another. I'm going to have my friend, 0:30 Brian, help me out in demonstration here. 0:33 Now, if you guys start with just 0:35 remembering what apprehension position 0:37 of the shoulder is, everything else we do 0:40 with the different naming of these tests, 0:43 I think, will fall into play a little 0:45 easier. So, apprehension position is about 0:49 90 degrees of shoulder abduction and 0:52 maximal external rotation. So. what you'll 0:56 find is that individuals who have anterior 0:58 shoulder laxity, or shoulder instability, 1:00 do not like to be put in this position. 1:02 If you try to bring them back in this 1:05 position, what they'll do is they'll 1:07 guard, and you'll see their face change. It's 1:10 not necessarily pain, but it's this feeling 1:14 that their shoulder is going to fall out 1:15 of its socket. You need to communicate 1:17 with your patient, and be like, "Hey, hey, 1:19 why won't you relax? Can you relax for me, 1:22 or no? No, you just feel like your 1:25 shoulder's going to fall out." Alright, so 1:30 Brian, here, actually has a little bit of apprehension. That's not him guarding. 1:32 He'll let me back there, but I 1:36 kind of have to stabilize him a little 1:37 bit, which now gets into the different 1:39 namings of these tests. The original 1:41 apprehension test, guys, is you either 1:43 have the individual- scoot over just a 1:45 little bit that way- have the individual 1:48 on the table so that the table is behind 1:51 their shoulder, so as you push down- go 1:54 ahead and flex your elbow for me- as you 1:56 press down into abduction and external 1:59 rotation or horizontal abduction 2:01 and external rotation, you have a 2:03 teeter-totter effect, or sea-saw effect 2:05 with the table. The table is pushing 2:07 their humeral head anteriorly, and that's 2:11 what provokes their symptoms. 2:13 That's what gets that feeling of 2:16 apprehension going, because they feel 2:18 like their shoulder's going to pop right out 2:19 of its socket. Now, in some texts you'll 2:22 see a hand underneath the shoulder 2:24 that's trying to do the same thing of 2:26 driving the humeral head anteriorly. So, 2:28 scoot over just a little bit this way. 2:30 It's essentially the same test. You're 2:33 doing this. I'm pressing 2:37 forward with this hand, posterior to 2:39 anterior, while going back into external 2:42 rotation, horizontal abduction at about 2:45 90 degrees of abduction. Now, there's this 2:48 thing called the lift-off, or surprise 2:50 test. Scoot back over. That's still the 2:53 apprehension position. But, this 2:56 time I'm going to use my 2:58 palm to stabilize the humeral head, so 3:02 that I can get back into position, and 3:05 then I'm going to let go. It's kind of mean, 3:08 honestly. This test is, once you let 3:12 go, it's a positive if all of a sudden 3:15 they guard on you, or they cringe, or they 3:17 feel pain. Alright, so now we have the 3:21 the apprehension test, and this is 3:24 is the 3:27 lift-off test. You also have Jobe's 3:30 relocation test, which is essentially the 3:33 apprehension test. If that gives them 3:36 symptoms, and then stabilizing the humeral 3:41 head as you pull them back makes those 3:43 symptoms better, then that's a positive 3:45 Jobe's relocation. And then, you have the 3:48 modified Jobe's relocation test, which is 3:50 just the same test at 120 degrees of 3:53 abduction. So, that causes them symptoms, 3:55 and if I stabilize the humeral head, that 3:59 feels better. Alright, so apprehension 4:03 test- positive is causes symptoms; lift-off 4:07 test- start with stabilization and let go 4:10 causes symptoms; relocation test- you 4:12 had symptoms and then you stabilized and 4:15 didn't. All of those are good indicators 4:18 of anterior shoulder laxity. Thank you, 4:22 Brian. Now, as far as a cluster for 4:26 anterior 4:26 your shoulder laxity, it ends up that a 4:29 good cluster is the apprehension test 4:31 combined with Jobe's relocation test, which 4:35 kind of makes sense. We already 4:37 talked about how the Jobe's relocation 4:38 test is simply stabilizing the humeral 4:41 head after you've already gotten 4:44 positive signs in the apprehension 4:46 position. For whatever reason, when 4:51 the statistics are looked at, combining 4:53 those two tests with the lift-off test, 4:56 it doesn't do anything to increase our 4:59 odds of getting the right diagnosis. 5:03 From my perspective, and from trying to 5:05 use this test in clinic, the lift-off 5:08 test can be kind of mean. You're putting 5:11 somebody back into a position that they 5:12 normally wouldn't put themselves in, 5:14 because you falsely stabilize their 5:16 humeral head, and then you let go and, of 5:20 course, they're going to have symptoms if 5:22 they have that pathology. And now that 5:25 you've got them back there, they'll 5:27 try to pull back on you 5:29 real hard, which might cause them a fair 5:32 amount of pain. It actually might 5:33 cause them to be flared up if this is 5:36 somebody who's already a little 5:39 geared up, a little inflamed, has already 5:42 been complaining of symptoms for a while. 5:44 So, there you guys have it. You have four 5:46 tests that are all very simple, very 5:50 similar. Just remember what your 5:53 apprehension position is, and then it 5:55 just comes down to hand position. Do you 5:57 want to add a little posterior to 5:59 anterior force to make the test more 6:01 provocative? Do you want to stabilize the 6:03 humeral head and see if that improves 6:05 things? And, of course, your cluster is 6:07 just the apprehension test alone, 6:09 followed by Jobe's relocation. I hope you 6:12 guys enjoyed this video. Add this 6:15 assessment to your repertoire. I think 6:17 you will find that there is a fair 6:19 number of individuals who have this 6:22 anterior shoulder laxity. This does 6:25 play a huge part in our exercise 6:27 selection, as individuals who have 6:29 hypermobility are going to require a lot 6:33 less release techniques, probably do not 6:37 need stretching or lengthening 6:39 techniques for the glenohumeral joint, 6:40 and are going to require far more from 6:44 the activation, stabilization and 6:46 integration side of our corrective 6:49 exercise continuum. I look forward to 6:51 hearing from you guys. Please leave your 6:52 questions in the comments boxes below. 7:02
