Anterior/apprehension release OR surprise test

Anterior/apprehension release OR surprise test | Shoulder

Purpose of Test: To assess for anterior instability of the glenohumeral joint capsule.

Test Position: Supine

Procedure: The examiner flexes the patient’s elbow to 90 degrees and abducts their shoulder to 90 degrees. The examiner then slowly externally rotates the patient’s shoulder. The test is considered positive if the patient demonstrates apprehension during shoulder external rotation.

Apprehension-Relocation method: The examiner flexes the patient’s elbow to 90 degrees and abducts their shoulder to 90 degrees. The examiner then slowly externally rotates the patient’s shoulder. If the patient experiences apprehension during external rotation, the examiners places a firm hand over the anterior shoulder, increasing shoulder stability. The examiner again applies an external rotation force to the shoulder. If the patient has apprehension during the first external rotation and no apprehension during the second external rotation, it is considered a positive test.

Importance of Test: Patients that demonstrate shoulder instability are at an increased risk of shoulder injury and dislocation. The causes of shoulder instability can be traumatic, micro traumatic, or genetic. Regardless of the mechanism of injury, these patients will often have muscle length discrepancies, lengthened joint capsules, and/or other connective tissue problems. Specifically, with anterior apprehension, the most common injury is known as a Bankart lesion. In a Bankart lesion, there is a detachment of the anterior-inferior labrum with its attached to the anterior portion of the inferior glenohumeral ligament.

Other causes of anterior instability include superior labral anterior and posterior (SLAP) detachment and humeral avulsion of the glenohumeral ligaments (HAGL). Regardless of the which specific structure is injured, it is important to spot an apprehension sign because a dislocated shoulder can cause damage to the surrounding nerves and vascular supply.

Note: these tests should only be performed by properly trained health care practitioners.

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