Which test is used to assess anterior instability?

• A. Sulcus sign
• B. Jerk test
• C. Push-Pull test
• D. Apprehension test

Answer: (D)

Pushing the exam to reproduce anterior displacement of the humeral head directly tests anterior instability. In the Apprehension test, the shoulder is placed in about 90 degrees of abduction with the elbow flexed, then the arm is gently externally rotated to its end range. If there is anterior laxity or a capsulolabral injury, the patient will become apprehensive or fearful of a dislocation, sometimes with maneuvers eliciting pain or grimacing. This reaction specifically signals that the structures stabilizing the front of the joint are compromised.

The other tests examine instability in different directions or aspects of the shoulder. The sulcus sign checks for inferior laxity and general multidirectional instability rather than a focused anterior instability. The jerk test looks for posterior instability or posterior labral pathology. The push-pull test assesses other aspects of shoulder stability and is not as specific for anterior instability as the apprehension test.