title: The supine apprehension test helps predict the risk of recurrent instability after a first-time anterior shoulder dislocation.
abstract: BACKGROUND
  We previously identified the positive result of the supine apprehension test after completion of rehabilitation following a first dislocation as a possible predictor of high risk for redislocation. We extend the follow-up of a previous cohort of patients with first-time shoulder dislocations to better assess this test.
  
  
  METHODS
  Fifty-three men aged 17 to 27 years who sustained a first traumatic shoulder dislocation were treated by shoulder immobilization for 4 weeks and then rehabilitated with a standard physical therapy protocol. At 6-week follow-up, a supine anterior apprehension test was performed to assess the risk of redislocation. The patients were observed prospectively for a minimum of 75 months.
  
  
  RESULTS
  Of the 53 participants, 52 (mean age, 20.2 years) completed the study follow-up. Of the 52 subjects, 41 (79%) were combat soldiers. Follow-up was between 75 and 112 months. Of the 52 subjects, 31 (60%) redislocated at a range of 3 to 70 months after the initial dislocation. Eleven of 14 subjects (79%; confidence interval, 52%-92%) with a positive anterior apprehension test result redislocated, compared with 20 of 38 patients (53%; confidence interval, 37%-68%) with a negative test result. Patients with a positive test result redislocated more and earlier (P = .02, PROC LIFETEST, SAS).
  
  
  CONCLUSIONS
  The results of the supine apprehension test after a first shoulder dislocation and rehabilitation can help predict risk for recurrent instability. It potentially may be included as a variable in decision analysis models.
authors.affiliation: Tsameret, Hebrew University Medical School, Ein Kerem, Jerusalem, Israel. Electronic address: charlesm@ekmd.huji.ac.il.
authors.forename: Charles
authors.initials: C
authors.lastname: Milgrom
authors.affiliation: Department of Internal Medicine, Hadassah University Hospital, Mt Scopus, Jerusalem, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Milgrom
authors.affiliation: Trinity Laban Counselling Service, Metanoia Institute, London, UK.
authors.forename: Denitsa
authors.initials: D
authors.lastname: Radeva-Petrova
authors.affiliation: Department of Orthopaedic Surgery, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.
authors.forename: Saleh
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Department of Orthopaedic Surgery, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Saul
authors.initials: S
authors.lastname: Beyth
authors.affiliation: Department of Orthopaedics, Assaf Harofeh Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Aharon S
authors.initials: AS
authors.lastname: Finestone
mesh_terms: D000293:Adolescent; D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000175:diagnosis*; D008297:Male; D010808:Physical Examination; D026741:Physical Therapy Modalities; D012008:Recurrence; D012306:Risk; D012307:Risk Factors; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000534:rehabilitation / Q000628:therapy; D012785:Shoulder Joint; D055815:Young Adult
keywords: Shoulder dislocation; anterior apprehension test; recurrent dislocation; risk; soldiers