Posterior glenohumeral instability can be tested by:
Correct Answer: Jerk test
Description: Jerk test Repeat from May 09 Tests for Anterior shoulder instability Anterior shoulder drawer test- With the patient supine, the scapula is stabilized with one hand while the upper arm is grasped firmly with the other so as to manipulate the head of the humerus forwards and backwards (like a drawer). Apprehension test (Crank test) - this is a provocative test in which the examiner cautiously lifts the arm into abduction, external rotation and then extension, at the crucial moment the patient senses that the humeral head is about to slip out anteriorly and his body tautens in apprehension. Relocation test - this test involves placing the shoulder in the position of apprehension and applying a posteriorly directed force on the humeral head. The result is considered positive if this relieves the patient's apprehension. Fulcrum test- With the patient supine, the clinician takes the shoulder into 90 degrees abduction and adds lateral rotation and extension. The test indicates anterior instability if the patient becomes apprehensive. Tests for Posterior shoulder instability Jerk test- With the patient sitting and the shoulder abducted to 90 degrees and medially rotated, the clinician applies a longitudinal cephalad force to the humerus and moves the arm into horizontal flexion. A positive test is indicated if there is a sudden jerk as the arm is moved into horizontal flexion and as it is returned to the sta position. Posterior drawer test- The examiner passively displaces the huymeral head in a posterior direction. Pain, clicking, or an increase in humeral head translation indicates a positive test. Posterior apprehension test- The patient lies supine, with the shoulder flexed and internally rotated and with the elbow flexed and resting on the trunk. A posterior force is transmitted by the examiner through the subject's elbow. A look of apprehension and resistance to fuher movement constitutes a positive result. Push-pull test- The patient is positioned supine with the shoulder placed at a 90 degrees of scapular plane abduction. The examiner grasps the subject's wrist with one hand while the other hand is placed anteriorly near the humeral head. The examiner simultaneously pulls upward through the long axis of the forearm while pushing the humeral head posteriorly. A look of apprehension or displacement of the humeral head greater than 50% represents a postitive test. Circumduction test- The patient is in standing position. The examiner stands behind the patient grasping the patient's forearm with the hand. The examiner begins circumduction by extending the patient's arm while mainting slight abduction. As the circumduction continues into elevation, the arm is brought over the top and into the flexed and adducted postion. As the arm moves into forward flexion and adduction from above, it is vulnerable to posterior subluxation if the patient is unstable posteriorly. If the examiner palpates the posterior aspect of the patient's shoulder as the arm moves downward in forward flexion and adduction, the humeral head will be felt to subluxate posteriorly in a positive test. Jahnke test- A posteriorly directed force applied to the forward flexed shoulder. The shoulder is then moved into the coronal plane as an anterior directed force is applied to the humeral head. A clunk occurs as the humeral head reduces from the subluxed position. Tests for Inferior shoulder instability Sulcus sign- The patient stands with the arm by the side and shoulder muscles relaxed. The examiner grasps the patient's forearm below the elbow and pulls the arm distally. A positive test suggesting inferior instability of the shoulder is indicated if the patient's pain is reproduced and/or a sulcus appears distal to the acromian.
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Surgery
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