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