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Posterior Apprehension
Purpose: To test for posterior glenohumeral capsular laxity and/ or posterior labrum.
Test Position: Supine.
Performing the Test: The examiner places the tested arm in 90 degrees shoulder flexion, neutral rotation, and 100-105 degrees of horizontal adduction. Next, the examiner places their other hand underneath the patient's scapula for support & applies a force through the long axis of the humerus. Assess the patient's response. A positive test is indicated if the long axis force reproduces a sense of apprehension and increased muscle guarding to prevent posterior shoulder dislocation.
Diagnostic Accuracy: Unknown.
Importance of Test: Multidirectional instability (MDI) at the shoulder was first defined by Neer and Foster in 1980. Many cases of MDI are atraumatic and related to repetitive overuse, such as baseball throwing or swimming. In addition to being unstable in multiple directions, patients with MDI have excessive shoulder capsule laxity. Factors that are correlated with MDI are decreased muscular control, ligamentous laxity, labral stabilization, and biomechanical abnormalities. Typical treatment for MDI includes 1-year of conservative exercise based treatment before being considered for surgery. While the majority of dislocations occur anteriorly, posterior dislocations do occur. The 2 major constraints against posterior instability are posterior capsule laxity and laxity in the posterior band of the inferior glenohumeral ligament. "The posterior glenoid, articular cartilage, and periosteum are also important static stabilizers" preventing posterior instability." By placing the patients are in 100-105 degrees of horizontal adduction and applying a long axis force, we are testing the strength of these structures. Instability will cause the patient to present with apprehension.
Note: these tests should only be performed by properly trained health care practitioners.
Test Position: Supine.
Performing the Test: The examiner places the tested arm in 90 degrees shoulder flexion, neutral rotation, and 100-105 degrees of horizontal adduction. Next, the examiner places their other hand underneath the patient's scapula for support & applies a force through the long axis of the humerus. Assess the patient's response. A positive test is indicated if the long axis force reproduces a sense of apprehension and increased muscle guarding to prevent posterior shoulder dislocation.
Diagnostic Accuracy: Unknown.
Importance of Test: Multidirectional instability (MDI) at the shoulder was first defined by Neer and Foster in 1980. Many cases of MDI are atraumatic and related to repetitive overuse, such as baseball throwing or swimming. In addition to being unstable in multiple directions, patients with MDI have excessive shoulder capsule laxity. Factors that are correlated with MDI are decreased muscular control, ligamentous laxity, labral stabilization, and biomechanical abnormalities. Typical treatment for MDI includes 1-year of conservative exercise based treatment before being considered for surgery. While the majority of dislocations occur anteriorly, posterior dislocations do occur. The 2 major constraints against posterior instability are posterior capsule laxity and laxity in the posterior band of the inferior glenohumeral ligament. "The posterior glenoid, articular cartilage, and periosteum are also important static stabilizers" preventing posterior instability." By placing the patients are in 100-105 degrees of horizontal adduction and applying a long axis force, we are testing the strength of these structures. Instability will cause the patient to present with apprehension.
Note: these tests should only be performed by properly trained health care practitioners.
References:
Lee , Hui. "Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography." Department of Radiology, University of Konkuk. (2012): n. page. Web. 10 Oct. 2012.
Remia, Leonard . "Biomechanical Evaluation of Multidirectional Glenohumeral Instability and Repair." Clinical Orthopaedics and related Research. (2003): 225-236.
Web. 10 Oct. 2012.
Lee , Hui. "Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography." Department of Radiology, University of Konkuk. (2012): n. page. Web. 10 Oct. 2012.
Remia, Leonard . "Biomechanical Evaluation of Multidirectional Glenohumeral Instability and Repair." Clinical Orthopaedics and related Research. (2003): 225-236.
Web. 10 Oct. 2012.
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