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

Abstract

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 painwith 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.