Sulcus Sign

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 Sulcus Sign

What is Sulcus Sign?

Sulcus Sign is used to detect inferior instability due to a laxity of the superior glenohumeral and coracohumeral ligaments (Multidirectional Instability).

It was described by Neer and Foster in 1980 1.

How it’s Performed?

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.

What does a positive Sulcus Sign mean?

The sulcus sign can be graded by measuring the distance from the inferior margin of the acromion to the humeral head:

  1. A distance of less than 1 cm is graded as 1+ sulcus.
  2. 1–2 cm as a 2+ sulcus.
  3. Greater than 2 cm as a grade 3+ sulcus.
GradeAcromiohumeral Interval
Grade +1< 1 cm
Grade +21- 2 cm
Grade +3> 2 cm
Sulcus Grading System

Sensitivity & Specificity

Tzannes and Murrell 2 found that a positive sulcus sign of more than 2 cm had a sensitivity of 28% and a specificity of 97%.


Related Anatomy

Superior glenohumeral ligamentThe Glenoid labrumAnatomical neck of the humerusRestrains external rotation and inferior translation of adducted or slightly abducted arm
Coracohumeral ligamentLateral border of the coracoid processThe lesser and greater tubercles of the humerusRestrains inferior translation and external rotation of adducted arm
shoulder ligaments anatomy
Shoulder ligaments anatomy


  1. Neer CSI, Foster CR: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. J Bone Joint Surg 62A:897– 908, 1980.
  2. An assessment of the interexaminer reliability of tests for shoulder instability.Tzannes A, Paxinos A, Callanan M, Murrell GAJ Shoulder Elbow Surg. 2004 Jan-Feb; 13(1):18-23. PMID: 14735068
  3. Callanan M, Tzannes A, Hayes KC, et al: Shoulder instability. Diagnosis and management. Aust Fam Physician 30:655–661, 2001.
  4. Clinical Tests for the Musculoskeletal System 3rd Ed. Book.
  5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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