Sulcus Sign

Sulcus Sign is used to test for multidirectional instability (MDI) of the shoulder joint.
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 Sulcus Sign

What is Sulcus Sign?

  • Sulcus Sign is used to test for multidirectional instability (MDI) of the shoulder joint.

How it's Performed?

  • The patient is seated or standing.
  • With one hand, the examiner stabilizes the patient’s contralateral shoulder while applying a distal pull on the patient’s relaxed affected arm with the other hand.
  • This is best done by grasping the patient’s arm at the elbow, with the elbow slightly flexed.

What does a positive Sulcus Sign mean?

  • If there is a sulcus that forms at the superior aspect of the humeral head, the test is positive.
  • Sulcus sign is considered positive if it stays increased (2+ or 3+) with ER at side (pathologic rotator interval).

Sensitivity & Specificity

  • Sensitivity: 28 %
  • Specificity: 97 %


  • Gradation in the clinical assessment of the sulcus sign is expressed in millimeters.
  • In reference to the grade of inferior instability, however, there is a large range of physiologic and individual variation.
  • The sulcus sign may be graded by measuring from the inferior margin of the acromion to the humeral head.
  • Grade II/III implies a distance of about 2 to 3 cm.
  • A high-grade sulcus sign (grade III) is a sign of multidirectional instability.

  • The test can also be performed so that the examiner supports the patient’s 90°-abducted arm .
  • Applying pressure to the proximal one-third of the upper arm from above can then provoke distal subluxation of the humeral head.
  • This will create a significant step-off beneath the acromion.
  • Aside from testing for the sulcus sign in the neutral position, it is recommended to perform the test with the arm externally and internally rotated as well.
  • Increased inferior translation in external rotation suggests elongation of the rotator interval.
  • A positive sign that occurs with the arm in internal rotation demonstrates laxity of the posterior capsular structures.


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Sulcus Sign

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