Clunk Test

The Clunk Test is used to diagnosis the superior anterior and posterior glenoid labral tear and sometimes anterior shoulder instability.

The glenoid labrum, a fibrocartilaginous rim attached to the glenoid cavity, plays a crucial role in shoulder stability. When compromised, it can lead to various shoulder pathologies. The Clunk Test was developed as a clinical examination technique to assess the integrity of the labrum and evaluate potential tears.

See Also: Shoulder SLAP Lesion

How to Perform the Clunk Test?

The patient lies supine. The examiner places one hand on the posterior aspect of the shoulder over the humeral head. The examiner’s other hand holds the humerus above the elbow. The examiner fully abducts the arm over the patient’s head. The examiner then pushes anteriorly with the hand over the humeral head (a fist may be used to apply more anterior pressure) while the other hand rotates the humerus into lateral rotation.

The examiner may modify the test by varying the degrees of abduction, essentially “circling the shoulder.” This variation allows for the evaluation of different segments of the labrum, providing a more complete diagnostic picture.

See Also: Normal Shoulder Range of Motion

What does a Positive Clunk Test mean?

The most definitive indication is an audible or palpable clunk or grinding sensation during the maneuver. This sound or sensation typically indicates a tear in the labrum.

Additionally, the test may elicit apprehension in patients with anterior instability.

An important variation noted by Walsh involves following the initial maneuver with horizontal adduction to relocate the humerus. During this relocation movement, a secondary clunk or click may be heard, further confirming the presence of a labral tear.

Reliability and Validity

Current evidence suggests that the Clunk Test’s diagnostic accuracy increases when combined with other clinical tests for labral tears, such as the O’Brien’s test and the Anterior Slide Test. This multi-test approach provides a more comprehensive clinical picture and helps improve diagnostic accuracy.

References & More

1. Walsh T, Winkel D, Kachingwe AF, et al. Clinical examination of the shoulder. In: Physical Therapy of the Shoulder. Churchill Livingstone; 2016:123-156.
2. Magee DJ. Orthopedic Physical Assessment. 6th ed. Elsevier; 2014.
3. Andrews JR, Gillogly S. Physical examination of theshoulder in throwing athletes. In: Zarins B, AndrewsJR, Carson WG, eds. Injuries to the Throwing Arm.Philadelphia: WB Saunders; 1985.
4. Clunk Test – Physiopedia