Execution
- 1Begin with the shoulder in the apprehension-relocation position.
- 2Apply posterior pressure to the humeral head until apprehension or symptoms reduce.
- 3Carefully release the posterior stabilizing force while maintaining the abducted and externally rotated position.
- 4Watch for return of apprehension, pain, or anterior humeral translation.
- 5Stop immediately if the patient becomes highly apprehensive or unstable.
Positive outcome
Return of apprehension, pain, or anterior translation when posterior pressure is released is positive. Magee warns that the release manoeuvre can cause distrust or even dislocation and should be done carefully.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Lo et al. (2004) | NA | 92 | 89 | 8.36 | 0.09 |
CommentThe surprise test has strong diagnostic utility in traumatic anterior instability but is also the most provocative part of the sequence. It may produce pain in older patients with rotator cuff pathology even without true instability. Use selectively, especially when apprehension and relocation already give a clear answer.
Moderate Clinical Value