Dugas Test

The Dugas Test serves as a valuable clinical examination tool in the assessment of suspected anterior shoulder dislocations. This test, while simple to perform, provides clinicians with a reliable method for differentiating between anterior shoulder dislocation and other shoulder pathologies, particularly those involving the acromioclavicular (AC) joint.

This test was first described by Louis Alexander Dugas de Vallon who was an American surgeon (1806 – 1884).

How to perform the Dugas Test?

The Dugas test’s effectiveness is based on the biomechanical limitations imposed by an anteriorly dislocated humeral head. In an anterior dislocation, the humeral head typically lies anterior and inferior to the glenoid fossa, creating a mechanical block that prevents normal shoulder movement patterns.

Dugas Test Procedure:

Patient Position: Patient should be in a comfortable seated or standing position. Ensure the patient is stable and can follow instructions

Test Steps: Ask the patient to place the hand of the affected arm on the opposite shoulder. Request the patient to lower the elbow toward the chest wall. Observe for ability to complete the movement and note any pain response

What is the positive Dugas Test?

The Dugas Test is Positive Test if:

• Patient unable to lower elbow to chest
• Significant pain in the shoulder region
• Indicates likely anterior shoulder dislocation

While it’s Negative Test if:

• Patient able to lower elbow to chest
• Minimal or no pain during movement
• Suggests absence of anterior dislocation

Clinical Pearls

Pain Location: If pain is localized specifically to the AC joint during the test, consider AC joint pathology rather than glenohumeral dislocation.

Document precise location of pain for differential diagnosis.

Test Limitations: False positives may occur in cases of severe shoulder pain or muscle spasm, therefor this test should be used in conjunction with other clinical tests and imaging studies.

It’s not recommended in cases of suspected fracture-dislocation.

Documentation:

Record specific findings including:

• Degree of movement limitation
• Pain location and intensity
• Any associated symptoms

Differential Diagnosis

When performing Dugas Test, consider the following conditions:

• Anterior shoulder dislocation
• AC joint injury
• Rotator cuff pathology
• Adhesive capsulitis
• Glenohumeral arthritis

Clinical Integration

Dugas Test should be integrated into a comprehensive shoulder examination protocol, including:

• Detailed history
• Visual inspection
• Range of motion testing
• Other special tests (e.g., Apprehension & Relocation test)
• Appropriate imaging studies

See Also: Shoulder Range of Motion

Conclusion

Dugas Test remains a valuable clinical tool in the assessment of suspected anterior shoulder dislocations. While not definitive in isolation, when properly performed and interpreted within the context of a complete clinical examination, it provides valuable diagnostic information to guide further evaluation and management decisions.

References & More

1. Orthopedic Physical Assessment by David J. Magee, 7th Edition
2. Evans RC. Illustrated Essentials in Orthopedic Physical Assessment. St Louis: Mosby Year Book; 1994.
3. Whonamedit – Dugas’ test or sign