Apprehension Test (Skulder)
- Fysiobasen
- Oct 4
- 2 min read
The Apprehension Test is primarily used to evaluate the stability of the glenohumeral joint and to assess the integrity of the joint capsule. It is particularly relevant when anterior shoulder instability is suspected, such as following previous dislocations or subluxations.
Technique
The patient lies supine on the examination table.
The examiner flexes the patient’s elbow to 90°.
The shoulder is abducted to 90° in the sagittal plane and approximately 180° in the frontal plane (horizontal abduction), with the shoulder in neutral rotation.
A gradual external rotation of the shoulder is applied towards 90°, while carefully monitoring the patient’s response¹.
Positive Test
The test is considered positive if the patient demonstrates apprehension (fear of dislocation) during external rotation. This strongly suggests anterior instability of the shoulder joint.
If the patient experiences only pain without apprehension, the finding may indicate another pathology, such as posterior impingement of the rotator cuff².
Diagnostic Accuracy
The diagnostic values of the Apprehension Test have been widely studied:
Parameter | Value |
Test–retest reliability | 0.74–0.84 (good)⁵,⁶ |
Sensitivity | 53% |
Specificity | 99% |
Positive likelihood ratio (+LR) | 53.0 |
Negative likelihood ratio (–LR) | 0.47 |
The very high specificity means that a positive test is highly reliable for confirming anterior instability. However, the low sensitivity indicates that a negative test does not rule out instability.
Clinical Relevance
A positive Apprehension Test is often combined with the Jobe Relocation Test to further confirm anterior instability.
Research also indicates that asymptomatic individuals who test positive may have a higher risk of developing future shoulder dislocations⁷.
This makes the Apprehension Test a cornerstone in the clinical evaluation of patients with suspected instability following trauma, recurrent dislocations, or in athletes with a history of shoulder injuries. It is frequently used to guide decisions about rehabilitation or the need for surgical management.
Summary
Assesses anterior glenohumeral instability.
Positive finding = apprehension (fear), not just pain.
High specificity (99%), making it excellent for confirmation.
Best used in combination with other stability tests, especially the Jobe Relocation Test.
Highly relevant for athletes and patients with previous dislocations.
Sources:
Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
Cotter EJ, Hannon CP, Christian D, Frank RM, Bach BR. Comprehensive Examination of the Athlete’s Shoulder. Sports Health: A Multidisciplinary Approach. 2018 Feb 14;10(4):366–75.
Apprehension (Crank) Test for Anterior Shoulder Dislocation | Shoulder Instability. Available from: https://www.youtube.com/watch?v=_JA-qvXcUdQ
Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
Rabin A, Ofir Chechik, Olds M, Uhl TL, Efi Kazum, Deutsch A, et al. The supine moving apprehension test—Reliability and validity among healthy individuals and patients with anterior shoulder instability. 2023 Apr 18;175857322311701-175857322311701.
Owens BD, Campbell SE, Cameron KL. Risk factors for anterior glenohumeral instability. The American Journal of Sports Medicine [Internet]. 2014 Nov 1 [cited 2021 May 16];42(11):2591–6. Available from: https://pubmed.ncbi.nlm.nih.gov/25248922/
