Execution
- 1Perform the anterior apprehension test and record whether apprehension, not merely pain, is reproduced.
- 2Perform the relocation test and record whether apprehension or symptoms decrease with posterior humeral-head pressure.
- 3Perform the release / surprise test only if safe and clinically necessary.
- 4Count the cluster as positive when the instability pattern is reproduced by apprehension, relieved by relocation, and reproduced again with release.
- 5Avoid the surprise component in highly unstable, recurrently dislocating, or very fearful patients.
Positive outcome
A positive cluster is apprehension with the apprehension test, symptom relief with relocation, and return of apprehension / pain with surprise release. The three-test pattern is more meaningful than pain from any single manoeuvre.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Lo et al. (2004) | NA | NA | NA | NA | NA |
CommentThis is the standard rule-in sequence for traumatic anterior instability, but safety matters because the release portion can provoke strong apprehension or dislocation. Interpret the cluster by instability response, not general pain reproduction. If the patient has high apprehension or recurrent dislocations, document that the surprise component was avoided rather than forcing completion.
High Clinical Value