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Apprehension Tests (Apprehension, Surprise and Jobe's Relocation Tests)

Learn 3 reliable shoulder apprehension tests- the Apprehension Test, the Surprise Tests, and the Jobe's relocation test. Understand why and how to use these tests and how to interpret the results to diagnose shoulder instability.

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Transcript

00:04 - 00:05This is Brent of the Brookbush
00:05 - 00:07Institute, and in this video we're going to
00:07 - 00:09go over special, or orthopedic tests
00:09 - 00:11for the shoulder. In this video, we're
00:11 - 00:13going to go over our instability, or
00:13 - 00:16anterior laxity tests. That includes our
00:16 - 00:19apprehension test, our lift-off or
00:19 - 00:22surprise test, our Jobe's relocation test
00:22 - 00:25and our modified Jobe's relocation test. I
00:25 - 00:26think you'll find that all of these
00:26 - 00:29tests are very, very similar to one
00:29 - 00:30another. I'm going to have my friend,
00:30 - 00:33Brian, help me out in demonstration here.
00:33 - 00:35Now, if you guys start with just
00:35 - 00:37remembering what apprehension position
00:37 - 00:40of the shoulder is, everything else we do
00:40 - 00:43with the different naming of these tests,
00:43 - 00:45I think, will fall into play a little
00:45 - 00:49easier. So, apprehension position is about
00:49 - 00:5290 degrees of shoulder abduction and
00:52 - 00:56maximal external rotation. So. what you'll
00:56 - 00:58find is that individuals who have anterior
00:58 - 01:00shoulder laxity, or shoulder instability,
01:00 - 01:02do not like to be put in this position.
01:02 - 01:05If you try to bring them back in this
01:05 - 01:07position, what they'll do is they'll
01:07 - 01:10guard, and you'll see their face change. It's
01:10 - 01:14not necessarily pain, but it's this feeling
01:14 - 01:15that their shoulder is going to fall out
01:15 - 01:17of its socket. You need to communicate
01:17 - 01:19with your patient, and be like, "Hey, hey,
01:19 - 01:22why won't you relax? Can you relax for me,
01:22 - 01:25or no? No, you just feel like your
01:25 - 01:30shoulder's going to fall out." Alright, so
01:30 - 01:32Brian, here, actually has a little bit of apprehension. That's not him guarding.
01:32 - 01:36He'll let me back there, but I
01:36 - 01:37kind of have to stabilize him a little
01:37 - 01:39bit, which now gets into the different
01:39 - 01:41namings of these tests. The original
01:41 - 01:43apprehension test, guys, is you either
01:43 - 01:45have the individual- scoot over just a
01:45 - 01:48little bit that way- have the individual
01:48 - 01:51on the table so that the table is behind
01:51 - 01:54their shoulder, so as you push down- go
01:54 - 01:56ahead and flex your elbow for me- as you
01:56 - 01:59press down into abduction and external
01:59 - 02:01rotation or horizontal abduction
02:01 - 02:03and external rotation, you have a
02:03 - 02:05teeter-totter effect, or sea-saw effect
02:05 - 02:07with the table. The table is pushing
02:07 - 02:11their humeral head anteriorly, and that's
02:11 - 02:13what provokes their symptoms.
02:13 - 02:16That's what gets that feeling of
02:16 - 02:18apprehension going, because they feel
02:18 - 02:19like their shoulder's going to pop right out
02:19 - 02:22of its socket. Now, in some texts you'll
02:22 - 02:24see a hand underneath the shoulder
02:24 - 02:26that's trying to do the same thing of
02:26 - 02:28driving the humeral head anteriorly. So,
02:28 - 02:30scoot over just a little bit this way.
02:30 - 02:33It's essentially the same test. You're
02:33 - 02:37doing this. I'm pressing
02:37 - 02:39forward with this hand, posterior to
02:39 - 02:42anterior, while going back into external
02:42 - 02:45rotation, horizontal abduction at about
02:45 - 02:4890 degrees of abduction. Now, there's this
02:48 - 02:50thing called the lift-off, or surprise
02:50 - 02:53test. Scoot back over. That's still the
02:53 - 02:56apprehension position. But, this
02:56 - 02:58time I'm going to use my
02:58 - 03:02palm to stabilize the humeral head, so
03:02 - 03:05that I can get back into position, and
03:05 - 03:08then I'm going to let go. It's kind of mean,
03:08 - 03:12honestly. This test is, once you let
03:12 - 03:15go, it's a positive if all of a sudden
03:15 - 03:17they guard on you, or they cringe, or they
03:17 - 03:21feel pain. Alright, so now we have the
03:21 - 03:24the apprehension test, and this is
03:24 - 03:27is the
03:27 - 03:30lift-off test. You also have Jobe's
03:30 - 03:33relocation test, which is essentially the
03:33 - 03:36apprehension test. If that gives them
03:36 - 03:41symptoms, and then stabilizing the humeral
03:41 - 03:43head as you pull them back makes those
03:43 - 03:45symptoms better, then that's a positive
03:45 - 03:48Jobe's relocation. And then, you have the
03:48 - 03:50modified Jobe's relocation test, which is
03:50 - 03:53just the same test at 120 degrees of
03:53 - 03:55abduction. So, that causes them symptoms,
03:55 - 03:59and if I stabilize the humeral head, that
03:59 - 04:03feels better. Alright, so apprehension
04:03 - 04:07test- positive is causes symptoms; lift-off
04:07 - 04:10test- start with stabilization and let go
04:10 - 04:12causes symptoms; relocation test- you
04:12 - 04:15had symptoms and then you stabilized and
04:15 - 04:18didn't. All of those are good indicators
04:18 - 04:22of anterior shoulder laxity. Thank you,
04:22 - 04:26Brian. Now, as far as a cluster for
04:26 - 04:26anterior
04:26 - 04:29your shoulder laxity, it ends up that a
04:29 - 04:31good cluster is the apprehension test
04:31 - 04:35combined with Jobe's relocation test, which
04:35 - 04:37kind of makes sense. We already
04:37 - 04:38talked about how the Jobe's relocation
04:38 - 04:41test is simply stabilizing the humeral
04:41 - 04:44head after you've already gotten
04:44 - 04:46positive signs in the apprehension
04:46 - 04:51position. For whatever reason, when
04:51 - 04:53the statistics are looked at, combining
04:53 - 04:56those two tests with the lift-off test,
04:56 - 04:59it doesn't do anything to increase our
04:59 - 05:03odds of getting the right diagnosis.
05:03 - 05:05From my perspective, and from trying to
05:05 - 05:08use this test in clinic, the lift-off
05:08 - 05:11test can be kind of mean. You're putting
05:11 - 05:12somebody back into a position that they
05:12 - 05:14normally wouldn't put themselves in,
05:14 - 05:16because you falsely stabilize their
05:16 - 05:20humeral head, and then you let go and, of
05:20 - 05:22course, they're going to have symptoms if
05:22 - 05:25they have that pathology. And now that
05:25 - 05:27you've got them back there, they'll
05:27 - 05:29try to pull back on you
05:29 - 05:32real hard, which might cause them a fair
05:32 - 05:33amount of pain. It actually might
05:33 - 05:36cause them to be flared up if this is
05:36 - 05:39somebody who's already a little
05:39 - 05:42geared up, a little inflamed, has already
05:42 - 05:44been complaining of symptoms for a while.
05:44 - 05:46So, there you guys have it. You have four
05:46 - 05:50tests that are all very simple, very
05:50 - 05:53similar. Just remember what your
05:53 - 05:55apprehension position is, and then it
05:55 - 05:57just comes down to hand position. Do you
05:57 - 05:59want to add a little posterior to
05:59 - 06:01anterior force to make the test more
06:01 - 06:03provocative? Do you want to stabilize the
06:03 - 06:05humeral head and see if that improves
06:05 - 06:07things? And, of course, your cluster is
06:07 - 06:09just the apprehension test alone,
06:09 - 06:12followed by Jobe's relocation. I hope you
06:12 - 06:15guys enjoyed this video. Add this
06:15 - 06:17assessment to your repertoire. I think
06:17 - 06:19you will find that there is a fair
06:19 - 06:22number of individuals who have this
06:22 - 06:25anterior shoulder laxity. This does
06:25 - 06:27play a huge part in our exercise
06:27 - 06:29selection, as individuals who have
06:29 - 06:33hypermobility are going to require a lot
06:33 - 06:37less release techniques, probably do not
06:37 - 06:39need stretching or lengthening
06:39 - 06:40techniques for the glenohumeral joint,
06:40 - 06:44and are going to require far more from
06:44 - 06:46the activation, stabilization and
06:46 - 06:49integration side of our corrective
06:49 - 06:51exercise continuum. I look forward to
06:51 - 06:52hearing from you guys. Please leave your
06:52 - 06:56questions in the comments boxes below.
07:02 - 07:04

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