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Jobes Relocation Test

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Purpose

The purpose of the Jobe Relocation Test[1] also referred to as is to test for anterior instability of the glenohumeral joint.[2] It is particularly useful following a positive Apprehension Test to confirm instability or impingement.[3]

  • Relocation Test
  • Glenohumeral subluxation and relocation test
  • Fowler Test

Patient Positioning

  • The patient lies supine on an examination table.
  • The shoulder is abducted to 90 degrees, and the elbow is flexed to 90 degrees.

Procedure

  • The therapist applies an external rotation force to the shoulder. If the patient reports apprehension, the Apprehension Test is considered positive.
  •  The therapist then applies a posteriorly directed force to the shoulder. If the patient's apprehension or pain decreases, the Jobe Relocation Test is considered positive.
  •  It's crucial to return the arm to a neutral position before releasing the posterior force to prevent shoulder dislocation[4][5].

Interpretation

  • This test is often used following a positive Apprehension Test to confirm the presence of anterior shoulder instability or impingement.
  • A positive Jobe Relocation Test indicates possible diagnoses such as glenohumeral instability, subluxation, dislocation, or impingement.[6]
  • It is important to note that the therapist should always bring the arm back into a neutral position before releasing the relocation force (posterior glide of the head of the humerus) for risk of shoulder dislocation.
  • If apprehension diminishes with the relocation force, it suggests potential anterior instability or pseudolaxity of the glenohumeral joint or scapulothoracic joint, and possibly secondary impingement or a posterior SLAP lesion[7][8][5].
  • If the apprehension predominated when performing the Crank Test and disappears with the Jobe Relocation Test, the diagnosis can include a pseudolaxity ot anterior instability of the GH joint, or potentially the scapulothoracic joint. It is important to also consider a secondary impingement or a posterior SLAP labral legion.

Evidence

Sensitivity and Specificity & Likelihood Ratio[9]:[10]

Sensitivity = 0.30 (the ability of the test to rule a diagnosis IN, also understood as the true positive rate)

Specificity = 0.90 (the ability of the test to rule a diagnosis OUT, also understood as the true negative rate)

+LR = 3.0. (sensitivity / 1- specificity)

– LR = 0.77 (1- sensitivity / specificity)

Clinical Relevance

  • The Jobe Relocation Test is valuable in differentiating between shoulder pathologies. It helps in confirming anterior instability, especially when other tests like the Apprehension Test are positive[11]​ ​.
  • This test is particularly useful in athletes, such as baseball pitchers or tennis players, who often present with anterior shoulder instability due to repetitive overhead activities[12]​[13] ​.

References

  1. ↑ Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete: The relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18:963-975.
  2. ↑ Provencher, Matthew T. MD; Midtgaard, Kaare S. MD; Owens, Brett D. MD; Tokish, John M. MD. Diagnosis and Management of Traumatic Anterior Shoulder Instability. Journal of the American Academy of Orthopaedic Surgeons 29(2):p e51-e61, January 15, 2021. |
  3. ↑ Hendy B, Horneff JG. Anatomy and Physical Examination. In: The Foundations of Shoulder and Elbow Surgery. 1st ed. CRC Press; 2020. p. 43. Available from: https://api.taylorfrancis.com
  4. ↑ Speer KP, Hannafin JA, Altchek DW, Warren RF. An evaluation of the shoulder relocation test. Am J Sports Med. 1994;22:177-183.
  5. ↑ 5.0 5.1 Desai S. Anterior shoulder instability diagnosis: Clinical examination. In: 360° Around Shoulder Instability. First Online: 16 June 2020. p. 43-48.
  6. ↑ Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc.; 2008.
  7. ↑ Gaunche CA, Jones DC. Clinical testing for tears of the glenoid labrum. Arthroscopy. 2003;19:517-523.
  8. ↑ Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012 Nov 1;46(14):964-78.
  9. ↑ Nakagawa S, Toneda M, Hayashida K, Obata M, Fukushima S, Miyazaki Y. Forced shoulder abduction and elbow flexion test: a new simple clinical test to detect superior labral injury in the throwing shoulder. Arthroscopy. 2005; 21: 1290-1295.
  10. ↑ Farber AJ, Castillo R, Clough M, et al: Clinical assessment of three common tests for traumatic anterior shoulder instability. J Bone Joint Surg Am 2006; 88: pp. 1467-1474.
  11. ↑ Konin JG, Lebsack D, Valier A, Isear JA Jr. Special tests for orthopedic examination. 2024. Available from: books.google.com
  12. ↑ Proximal Biceps Pathology and SLAP Lesions. In: Orthopaedics and Trauma. 2024 May 4. p. 1133-43.
  13. ↑ Bassett AJ, Cohen SB. Instability in the Throwing Athlete. In: Shoulder Instability in the Athlete. 1st ed. CRC Press; 2020. p. 16.
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