Sulcus Sign is used to test for multidirectional instability (MDI) of the shoulder joint.
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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.
Medial Scapular Winging
Medial Scapular Winging is seen in: Serratus anterior muscle weakness & Long thoracic nerve dysfunction
Anterior Drawer test of the shoulder is used to test for Anterior Instability.
Gerber Test is used for Subcoracoid Impingement (between the rotator cuff and the coracoid process).
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