An Evaluation of the Shoulder Relocation Test

Abstract

The purpose of this study was to evaluate the sensitivity, specificity, negative and positive predictive values, and accuracy of the shoulder relocation test in 100 patients who underwent shoulder surgery. Based on operative data and examination under anesthesia, the diagnoses were grouped into six categories: anterior instability (without cuff disease), posterior instability, rotator cuff disease (without associated anterior instability), acro mioclavicular disorder, osteoarthrosis, and instability of the biceps tendon. The test was performed on the day of surgery by placing the arm in a position of 90° of humerothoracic abduction and 90° of external rotation (90°/90°). Patient responses of pain and apprehension (considered separately) were assessed in this position both with and without application of an anterior force to the proximal humerus. The relocation test assessed diminution of pain and apprehension after application of a posteriorly directed force to the proximal humerus relative to the position of 90°/90° alone and to the po sition of an anterior force being applied to the proximal humerus.

Overall, 63 patients reported pain with 90°/90°; 74 reported pain when an anterior force to the proximal humerus was applied: the anterior instability group alone had 46 and 63 reports of pain, respectively; the rotator cuff group alone had 82 and 88 reports of pain, respectively. The only positive responses for apprehen sion were in the anterior instability group, of which 63% had apprehension with 90°/90° alone and 74 had ap prehension when an anterior humeral force was ap plied. The overall accuracy of the shoulder relocation test was <50% when the response of pain alone was considered and >80% when the response of apprehen sion alone was considered. The performance of the test was contrasted within the anterior instability and rotator cuff disease groups. A positive relocation test for pain was observed in 30% (14 of 46) of the anterior instability group and in 44% (15 of 34) of the rotator cuff disease group; this increased to 54% (25 of 46) and 56% (19 of 34), respectively, with reference to the position of an anterior force on the proximal humerus.