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The American Journal of Sports Medicine 32:301-307 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

An Evaluation of the Apprehension, Relocation, and Surprise Tests for Anterior Shoulder Instability

Ian K. Y. Lo, MD, FRCSC*, Blake Nonweiler, MD{ddagger}, Michael Woolfrey, MD, FRCSC§, Robert Litchfield, MD, FRCSC||,a and Alexandra Kirkley, MD, FRCSC{dagger}

From the * University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada, the {ddagger} Orthopaedic and Fracture Clinic, Salem, Oregon, § Brantford General Hospital, Brantford, Ontario, Canada, and the a Division of Orthopaedic Surgery, Fowler Kennedy Sport Medicine Centre, University of Western Ontario, London, Ontario, Canada

|| Address correspondence to Dr. Robert Litchfield, Fowler Kennedy Sport Medicine Centre, 3M Centre, University of Western Ontario, London, Ontario, Canada N6A 3K7 (e-mail: rlitchf{at}uwo.ca).

Background: Although there are many studies describing tests for shoulder instability, there are few assessing the validity of these tests in diagnosing anterior shoulder instability.

Purpose: To assess the validity of the apprehension, relocation, and surprise tests as predictors of anterior shoulder instability.

Study Design: Retrospective review of prospectively collected data.

Methods: Forty-six patients with a clear diagnosis of one of the following shoulder disorders were evaluated by four independent, blinded examiners: traumatic anterior instability (18), rotator cuff tendinosis (17), posterior instability (2), glenohumeral osteoarthritis (4), or multidirectional instability (5). Interobserver reliability was also determined.

Results: In subjects who had a feeling of apprehension on all three tests, the mean positive and negative predictive values were 93.6% and 71.9%, respectively. The surprise test was the single most accurate test (sensitivity = 63.89%; specificity = 98.91%). An improvement in the feeling of apprehension or pain with the relocation test added little to the value of the tests. Interobserver reliability was determined to be 0.83.

Conclusions and Clinical Relevance: The results of this study suggest that a positive instability exam on all three tests is highly specific and predictive of traumatic anterior glenohumeral instability.

Key Words: shoulder instability • apprehension tests • relocation test




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