00:00:0400:00:05
This is Brent of the Brookbush
00:00:0500:00:07
Institute, and in this video we're going to
00:00:0700:00:09
go over special, or orthopedic tests
00:00:0900:00:11
for the shoulder. In this video, we're
00:00:1100:00:13
going to go over our instability, or
00:00:1300:00:16
anterior laxity tests. That includes our
00:00:1600:00:19
apprehension test, our lift-off or
00:00:1900:00:22
surprise test, our Jobe's relocation test
00:00:2200:00:25
and our modified Jobe's relocation test. I
00:00:2500:00:26
think you'll find that all of these
00:00:2600:00:29
tests are very, very similar to one
00:00:2900:00:30
another. I'm going to have my friend,
00:00:3000:00:33
Brian, help me out in demonstration here.
00:00:3300:00:35
Now, if you guys start with just
00:00:3500:00:37
remembering what apprehension position
00:00:3700:00:40
of the shoulder is, everything else we do
00:00:4000:00:43
with the different naming of these tests,
00:00:4300:00:45
I think, will fall into play a little
00:00:4500:00:49
easier. So, apprehension position is about
00:00:4900:00:52
90 degrees of shoulder abduction and
00:00:5200:00:56
maximal external rotation. So. what you'll
00:00:5600:00:58
find is that individuals who have anterior
00:00:5800:01:00
shoulder laxity, or shoulder instability,
00:01:0000:01:02
do not like to be put in this position.
00:01:0200:01:05
If you try to bring them back in this
00:01:0500:01:07
position, what they'll do is they'll
00:01:0700:01:10
guard, and you'll see their face change. It's
00:01:1000:01:14
not necessarily pain, but it's this feeling
00:01:1400:01:15
that their shoulder is going to fall out
00:01:1500:01:17
of its socket. You need to communicate
00:01:1700:01:19
with your patient, and be like, "Hey, hey,
00:01:1900:01:22
why won't you relax? Can you relax for me,
00:01:2200:01:25
or no? No, you just feel like your
00:01:2500:01:30
shoulder's going to fall out." Alright, so
00:01:3000:01:32
Brian, here, actually has a little bit of apprehension. That's not him guarding.
00:01:3200:01:36
He'll let me back there, but I
00:01:3600:01:37
kind of have to stabilize him a little
00:01:3700:01:39
bit, which now gets into the different
00:01:3900:01:41
namings of these tests. The original
00:01:4100:01:43
apprehension test, guys, is you either
00:01:4300:01:45
have the individual- scoot over just a
00:01:4500:01:48
little bit that way- have the individual
00:01:4800:01:51
on the table so that the table is behind
00:01:5100:01:54
their shoulder, so as you push down- go
00:01:5400:01:56
ahead and flex your elbow for me- as you
00:01:5600:01:59
press down into abduction and external
00:01:5900:02:01
rotation or horizontal abduction
00:02:0100:02:03
and external rotation, you have a
00:02:0300:02:05
teeter-totter effect, or sea-saw effect
00:02:0500:02:07
with the table. The table is pushing
00:02:0700:02:11
their humeral head anteriorly, and that's
00:02:1100:02:13
what provokes their symptoms.
00:02:1300:02:16
That's what gets that feeling of
00:02:1600:02:18
apprehension going, because they feel
00:02:1800:02:19
like their shoulder's going to pop right out
00:02:1900:02:22
of its socket. Now, in some texts you'll
00:02:2200:02:24
see a hand underneath the shoulder
00:02:2400:02:26
that's trying to do the same thing of
00:02:2600:02:28
driving the humeral head anteriorly. So,
00:02:2800:02:30
scoot over just a little bit this way.
00:02:3000:02:33
It's essentially the same test. You're
00:02:3300:02:37
doing this. I'm pressing
00:02:3700:02:39
forward with this hand, posterior to
00:02:3900:02:42
anterior, while going back into external
00:02:4200:02:45
rotation, horizontal abduction at about
00:02:4500:02:48
90 degrees of abduction. Now, there's this
00:02:4800:02:50
thing called the lift-off, or surprise
00:02:5000:02:53
test. Scoot back over. That's still the
00:02:5300:02:56
apprehension position. But, this
00:02:5600:02:58
time I'm going to use my
00:02:5800:03:02
palm to stabilize the humeral head, so
00:03:0200:03:05
that I can get back into position, and
00:03:0500:03:08
then I'm going to let go. It's kind of mean,
00:03:0800:03:12
honestly. This test is, once you let
00:03:1200:03:15
go, it's a positive if all of a sudden
00:03:1500:03:17
they guard on you, or they cringe, or they
00:03:1700:03:21
feel pain. Alright, so now we have the
00:03:2100:03:24
the apprehension test, and this is
00:03:2700:03:30
lift-off test. You also have Jobe's
00:03:3000:03:33
relocation test, which is essentially the
00:03:3300:03:36
apprehension test. If that gives them
00:03:3600:03:41
symptoms, and then stabilizing the humeral
00:03:4100:03:43
head as you pull them back makes those
00:03:4300:03:45
symptoms better, then that's a positive
00:03:4500:03:48
Jobe's relocation. And then, you have the
00:03:4800:03:50
modified Jobe's relocation test, which is
00:03:5000:03:53
just the same test at 120 degrees of
00:03:5300:03:55
abduction. So, that causes them symptoms,
00:03:5500:03:59
and if I stabilize the humeral head, that
00:03:5900:04:03
feels better. Alright, so apprehension
00:04:0300:04:07
test- positive is causes symptoms; lift-off
00:04:0700:04:10
test- start with stabilization and let go
00:04:1000:04:12
causes symptoms; relocation test- you
00:04:1200:04:15
had symptoms and then you stabilized and
00:04:1500:04:18
didn't. All of those are good indicators
00:04:1800:04:22
of anterior shoulder laxity. Thank you,
00:04:2200:04:26
Brian. Now, as far as a cluster for
00:04:2600:04:29
your shoulder laxity, it ends up that a
00:04:2900:04:31
good cluster is the apprehension test
00:04:3100:04:35
combined with Jobe's relocation test, which
00:04:3500:04:37
kind of makes sense. We already
00:04:3700:04:38
talked about how the Jobe's relocation
00:04:3800:04:41
test is simply stabilizing the humeral
00:04:4100:04:44
head after you've already gotten
00:04:4400:04:46
positive signs in the apprehension
00:04:4600:04:51
position. For whatever reason, when
00:04:5100:04:53
the statistics are looked at, combining
00:04:5300:04:56
those two tests with the lift-off test,
00:04:5600:04:59
it doesn't do anything to increase our
00:04:5900:05:03
odds of getting the right diagnosis.
00:05:0300:05:05
From my perspective, and from trying to
00:05:0500:05:08
use this test in clinic, the lift-off
00:05:0800:05:11
test can be kind of mean. You're putting
00:05:1100:05:12
somebody back into a position that they
00:05:1200:05:14
normally wouldn't put themselves in,
00:05:1400:05:16
because you falsely stabilize their
00:05:1600:05:20
humeral head, and then you let go and, of
00:05:2000:05:22
course, they're going to have symptoms if
00:05:2200:05:25
they have that pathology. And now that
00:05:2500:05:27
you've got them back there, they'll
00:05:2700:05:29
try to pull back on you
00:05:2900:05:32
real hard, which might cause them a fair
00:05:3200:05:33
amount of pain. It actually might
00:05:3300:05:36
cause them to be flared up if this is
00:05:3600:05:39
somebody who's already a little
00:05:3900:05:42
geared up, a little inflamed, has already
00:05:4200:05:44
been complaining of symptoms for a while.
00:05:4400:05:46
So, there you guys have it. You have four
00:05:4600:05:50
tests that are all very simple, very
00:05:5000:05:53
similar. Just remember what your
00:05:5300:05:55
apprehension position is, and then it
00:05:5500:05:57
just comes down to hand position. Do you
00:05:5700:05:59
want to add a little posterior to
00:05:5900:06:01
anterior force to make the test more
00:06:0100:06:03
provocative? Do you want to stabilize the
00:06:0300:06:05
humeral head and see if that improves
00:06:0500:06:07
things? And, of course, your cluster is
00:06:0700:06:09
just the apprehension test alone,
00:06:0900:06:12
followed by Jobe's relocation. I hope you
00:06:1200:06:15
guys enjoyed this video. Add this
00:06:1500:06:17
assessment to your repertoire. I think
00:06:1700:06:19
you will find that there is a fair
00:06:1900:06:22
number of individuals who have this
00:06:2200:06:25
anterior shoulder laxity. This does
00:06:2500:06:27
play a huge part in our exercise
00:06:2700:06:29
selection, as individuals who have
00:06:2900:06:33
hypermobility are going to require a lot
00:06:3300:06:37
less release techniques, probably do not
00:06:3700:06:39
need stretching or lengthening
00:06:3900:06:40
techniques for the glenohumeral joint,
00:06:4000:06:44
and are going to require far more from
00:06:4400:06:46
the activation, stabilization and
00:06:4600:06:49
integration side of our corrective
00:06:4900:06:51
exercise continuum. I look forward to
00:06:5100:06:52
hearing from you guys. Please leave your
00:06:5200:06:56
questions in the comments boxes below.