Apprehension Test

Original Editor - Tyler Shultz

Top Contributors - Tyler Shultz, Rachael Lowe, Scott Buxton, Kai A. Sigel and Naomi O'Reilly

Purpose

The Apprehension test is generally used to test the integrity of the glenohumeral joint capsule, or to assess glenohumeral instability in an anterior direction.

Technique

The patient should be position in supine.  The therapist will flex the patient's elbow to 90 degrees and abducts the patient's shoulder to 90 degrees, maintaining neutral rotation.  The examiner then slowly applies an external rotation force to the arm to 90 degrees while carefully monitoring the patient[1].  Patient apprehension from this maneuver, not pain, is considered a positive test.  Pain with the maneuver, but not apprehension may indicate a pathology other than instability, such as posterior impingement of the rotator cuff[2].

[3]

Evidence

Diagnostic Test Properties for the Apprehension Test[4]
Sensitivity   0.53
Specificity   0.99
Positive Likelihood Ratio   53.0
Negative Likelihood Ratio   0.47

Test Item Cluster: If found positive, the Apprehension test is often combined with the Jobes Relocation test.

See test diagnostics page for explanation of statistics.

References

  1. Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
  2. Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
  3. Physiotutors. Apprehension (Crank) Test for Anterior Shoulder Dislocation | Shoulder Instability. Available from: https://www.youtube.com/watch?v=hy7zgoEsbzQ
  4. Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion