Name: Apprehension Tests (Apprehension, Surprise and Jobe's Relocation Tests)
Uploaded: 2023-04-26T01:02:18.000Z
Duration: 7 min 4 s
Description: 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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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.

Introduction to Shoulder Instability Tests

Understanding the Apprehension Position

Demonstrating the Apprehension and Lift-Off Tests

Exploring Jobe's Relocation Tests

Understanding Test Cluster for Shoulder Laxity

Implications of Shoulder Instability on Exercise Selection

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

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

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Special tests for shoulder instability. The Apprehension Test, Jobe's Relocation Test, Composite SLAP Tear Test-item Cluster, Jobe's Relocation Test (Apprehension Tests), Biceps Load 2, Obrien's Active, Compression Test, Posterior Inferior Labral Lesion, Jerk Test, Speed's Test, Yergason's Test, Compression Rotation Test, Kim's Test. The reliability, specificity, sensitivity, validity, safety, and screening for shoulder pain, instability, labral tears, glenohumeral (shoulder) joint stability, SLAP tears, AC (acromioclavicular) joint pathology, and posterior to inferior labral lesions.

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