Inferior Sulcus Test
Original Editor - Tyler Shultz
Top Contributors - Rachael Lowe, Admin, Tyler Shultz, Kim Jackson, Pacifique Dusabeyezu, Wendy Snyders, Tony Lowe, WikiSysop, Evan Thomas, Naomi O'Reilly, Kai A. Sigel and Wanda van Niekerk
Purpose
The sulcus test is used to assess the glenohumeral joint for inferior instability, due to laxity of the superior glenohumeral ligament and coracohumeral ligament.[1]It was first described by Neer and Foster in 1980 to examine multidirectional instability.[2]
Technique
This test can be performed with the patient sitting, standing, or in a supine position with their shoulder in neutral (0 degrees rotation). The examiner then pulls the distal part of the humerus in a caudal direction[3][4]. However, the sitting position with arms by the side is considered to provide more reliable results as suggested by McFarland et al. [2]The test is considered positive when the appearance of sulcus in the subacromial space is more than 1cm as the humeral head translates in the inferior direction[3][2].
To enhance the diagnostic accuracy, the test should be performed twice, first with the arm in neutral rotation and second with the arm in external rotation. Inferior translation should be the same in both positions. An increased degree of inferior translation with the arm in external rotation suggests a potential lesion of the rotator interval.[2]
Evidence
The degree of displacement can be measured in centimeters. In general, grade I indicates a displacement of less than 1.5 cm, grade II between 1.5 and 2 cm, and grade III more than 2 cm. McFarland et al have proposed categorizing these values as low (grade I) and high (grades II and III). According to Tzannes and Murrell, a positive sulcus sign of more than 2 cm had a sensitivity of 28% and a specificity of 97%.[2]
However, it is important to note that a wide range of inferior laxity can be observed in asymptomatic individuals, suggesting that there is no absolute degree of inferior translation that defines inferior instability. Thus, careful interpretation of the test results in conjunction with other clinical findings is important[2] The sulcus test has been shown to have significant between-tester differences and has moderate reliability (κ 0.43)[3]
References
- ↑ Tzannes A, Murrell GA. Clinical examination of the unstable shoulder. Sports Medicine. 2002 Jun;32:447-57.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Valencia Mora M, Ibán MÁR, Heredia JD, Gutiérrez-Gómez JC, Diaz RR, Aramberri M, et al. Physical Exam and Evaluation of the Unstable Shoulder. Open Orthop J. 2017;11(1):946–56.
- ↑ 3.0 3.1 3.2 Eshoj H, Ingwersen KG, Larsen CM, Kjaer BH, Juul-Kristensen B. Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems. BMJ open. 2018 Mar 1;8(3):e018472.
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ bigesor. Sulcus Sign Test. Available from: https://www.youtube.com/watch?v=taN04xR4iAs [last accessed 10/7/2024]