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Updated: Aug 26, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability
Ian K Y Lo1, Blake Nonweiler, Michael Woolfrey
1University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada.
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 pain with 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.
