title: Clinical assessment of three common tests for traumatic anterior shoulder instability.
abstract: BACKGROUND
  Although traumatic anterior shoulder instability is common, the usefulness of various physical examination tests as tools for the diagnosis of this condition has been studied infrequently. We hypothesized that (1) such tests would be specific but not sensitive for this condition, (2) the usefulness of the anterior drawer test would be limited because of pain during the test, and (3) an anterior drawer test would be a useful adjunct for making the diagnosis if it reproduced the instability symptoms.
  
  
  METHODS
  Between 2000 and 2004, 363 patients underwent a physical examination followed by shoulder arthroscopy. Forty-six patients with traumatic anterior shoulder instability that had been noted arthroscopically or documented radiographically after the trauma were included in our study group, and the remaining patients served as controls. The clinical usefulness of three tests (anterior apprehension, relocation, and anterior drawer tests) performed during the physical examination to make a diagnosis of traumatic anterior instability then was evaluated with statistical methods to assess their sensitivity, specificity, and likelihood ratios.
  
  
  RESULTS
  If demonstration (or relief) of apprehension was used as the diagnostic criterion for a positive test, the sensitivity, specificity, and likelihood ratio were 72%, 96%, and 20.2, respectively, for the apprehension test and 81%, 92%, and 10.4, respectively, for the relocation test. If pain (or relief of pain) was used as the diagnostic criterion for a positive test, the values for the sensitivity, specificity, and likelihood ratio of both tests were lower. The anterior drawer test could be performed successfully in the physician's office for 87% of the patients. If reproduction of instability symptoms was used as the criterion for a positive anterior drawer test, the sensitivity, specificity, and likelihood ratio values of that test were 53%, 85%, and 3.6, respectively.
  
  
  CONCLUSIONS
  The three physical examination tests for traumatic anterior shoulder instability are specific but not sensitive. Apprehension is a better criterion than pain for a positive apprehension or relocation test. The anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability.
  
  
  METHODS
  Diagnostic Level I. See Instructions to Authors for a complete description of levels of evidence.
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21224, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Farber
authors.forename: Renan
authors.initials: R
authors.lastname: Castillo
authors.forename: Mark
authors.initials: M
authors.lastname: Clough
authors.forename: Michael
authors.initials: M
authors.lastname: Bahk
authors.forename: Edward G
authors.initials: EG
authors.lastname: McFarland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D009819:Office Visits; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000502:physiology*; D015203:Reproducibility of Results; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology*