Indications

Anterior Apprehension test is a shoulder stability examination to determine if there is anterior instability of the glenohumeral joint capsule. The test can also be referred to as Shoulder Apprehension sign or Crank test.

Procedure:

The examination can be performed either supine or seated.

  1. Patient supine with knee with elbow flexed to 90°.
  2. Examiner gently applies anterior pressure and observes patient for signs of apprehension or discomfort.
Positive Anterior Apprehension Test

Examiner gently applies anterior pressure and observes patient for signs of apprehension or discomfort.

Interpretation:

The examination is considered positive if there is an anterior translation or if the patient expresses apprehension during the test.

Positive Anterior Apprehension Test

    Excessive Anterior translation, dislocation or patient apprehension: anterior glenohumeral instability

Clinical Notes:

Pain is not always expected with this examination, but can be reported. The patient will usually indicate that they feel that their shoulder is unstable or that it’s about to dislocate. This is especially true if they’ve had previous episodes of subluxations or dislocations at the shoulder.

Grades of shoulder instability

Grade Description
Normal 0-25% translation
I 25-50% translation, humeral head riding up on glenoid labrum
II 50-75% translation, humeral head rides up & over glenoid labrum, but immediately reduces
III 75% translation & humeral head remains dislocated in cases of severe instability diagnostic imaging should be an immediate follow-up (MRI, X-ray)