Shoulder Orthopaedic Test: Apprehension Test

The Apprehension Test is a physical exam technique used to assess for glenohumeral joint instability, specifically anterior instability. Here is a step-by-step procedure for performing the test:

1. Have the patient lie supine on an examination table with their affected arm in 90 degrees of abduction and external rotation.
2. Stand next to the patient's affected side and grasp the patient's elbow with one hand.
3. Place your other hand on the patient's humeral head to support and stabilize it.
4. Slowly and gently externally rotate the patient's arm while applying anterior pressure to the humeral head.
5. Observe the patient's response to the maneuver.
6. If the patient experiences pain or discomfort, ask them if they feel like their shoulder is going to "pop out" or if they feel apprehensive about the maneuver.
7. If the patient reports apprehension or feels like their shoulder is going to "pop out," hold the patient's arm in that position and assess for any anterior translation or subluxation of the humeral head.
8. Repeat the test on the opposite shoulder for comparison.
9. If the patient experiences pain or apprehension or if there is excessive anterior translation or subluxation of the humeral head, further diagnostic testing or referral to a specialist may be necessary.

References:

1. Magee, D. J. (2014). Orthopedic Physical Assessment. Elsevier Health Sciences.
2. Meister, K. (2000). Injuries to the shoulder in the throwing athlete. Part one: biomechanics/pathophysiology/classification of injury. The American Journal of Sports Medicine, 28(2), 265-275.
3. O'Connor, F. G., Wilder, R. P., & Sutherland, C. A. (1998). Shoulder instability: evaluation and management. The American Family Physician, 57(7), 1647-1656.
4. Matsen III, F. A., & Rockwood Jr, C. A. (1998). The shoulder. WB Saunders.