Apprehension test
Supine or seated, arm in 90 º abduction, 90 º flexion in the elbow and external rotation. The examiner attempts to further force external rotation. Positive test: discomfort, pain, and fear that the shoulder will sublux/dislocate forward.
Test characteristics: Apprehension Sens 40, Spec 87, LR+3.08, LR-0.69
Relocation test
Supine position. The examiner applies a steady pressure on the humerus from the front so that the humeral head is held in place in the glenoid cavity. Then an apprehension test is performed. If the arm can then be further externally rotated without the same discomfort, the test is positive.
Test characteristics: Relocation Sens 33, Spec 87, LR+3.38, LR-0.64
Shoulder dislocation
- Over 95% of shoulder dislocations are anterior dislocations
- In anterior dislocation, the arm is usually held externally rotated and slightly abducted
- Hill-Sachs lesion is defined as an impression fracture of the humeral head, seen in 35-40% of cases of anterior dislocation
- Bankart lesion is defined as an injury to the anterior glenoid labrum with or without detachment of a bone fragment from the glenoid fossa
Anterior shoulder dislocation
Midtgaard KS, Bøe B, Lundgreen K et al. Anterior shoulder dislocation – investigation and treatment. Tidsskr Nor Legeforen 2021;141. Doi: 10.4045/tidsskr.20.0826.
Shoulder dislocation, reposition
Hanging arm for closed reduction of anterior shoulder dislocation. The patient lies on their stomach with the arm hanging over the edge. Pull on the arm or use weights. The practitioner pushes the lower corner of the shoulder blade toward the midline while simultaneously rotating and applying traction to the hanging arm.