The normal function of your shoulder can be disrupted because of many things and since most shoulder conditions seemingly have similar symptoms it is important to get an accurate diagnosis from a specialist. A variety of specialized shoulder tests can be employed by the doctor to find out if the patient is suffering from shoulder instability. Special tests are required to determine the precise cause of pain, whether it is a muscle or tendon problem, a joint impingement, or shoulder instability. The aim of these tests is to help with the diagnostic process and to decide on an effective treatment plan.
Before administering the tests, a complete history and physical examination will be done by a physician. Palpation is done to check for points of tenderness as well as checking the range of motion and strength. The degree of shoulder looseness or laxity of the shoulder joint can be assessed by specific tests. X-rays can be done to find the possible causes of the instability and to rule out other causes of shoulder pain like fracture. Certain additional tests like MRI scan or a dye test also known as an arthrogram may be done with or without a CT scan to further evaluate the bones and tissues of the shoulder joint and to look for damage to joints, bones, tendons, ligaments, and cartilage. These tests can also look for changes that happen over time.
Let’s look at the various tests that can be used to exactly pinpoint a shoulder instability condition.
The apprehension test is performed with the patient lying face-up on an exam table. The doctor extends the arm straight out off of the table. They then bend the elbow by 90 degrees. While stabilizing the shoulder with one hand the doctor then gently pulls the forearm toward the floor. This is called external rotation of the shoulder. If there is a sensation that the shoulder may pop out of its joint with pain or if it actually pops out of the joint, the test is positive. This test is used to confirm anterior instability.
When the symptoms of an anterior instability seem to improve, a relocation test is done to confirm improvement. The relocation test is performed by having a doctor place one hand on top of the patient’s shoulder to help put the joint back into place. There should be a feeling like the joint is in the right place.
Foe the Sulcus Test, the patient just hangs the arm down by their side. Taking hold of the patient’s wrist or elbow the arm is pulled down. The doctor will check for the appearance of a small divot, or sulcus, at the top of the shoulder joint. This indicates that the shoulder is pulling away from the socket and this is a sign of multidirectional shoulder instability.
Load and Shift Test
This test can help confirm both anterior or posterior instability. The patient sits with no back support. The scapula and clavicle are stabilized with one hand while the other “centers” the humeral head, then glides the humeral head anterior or posterior trying to determine the amount of translation.
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