Norwood Stress Test

The Norwood Stress Test is a physical examination used to detect the posterior instability of the shoulder joint.

How to perform the Norwood Stress Test?

The patient lies supine with the shoulder abducted 60° to 100° and laterally rotated 90° and with the elbow flexed to 90°, so that the arm is horizontal. The examiner stabilizes the scapula with one hand, palpating the posterior humeral head with the fingers, and stabilizes the upper limb by holding the forearm and elbow at the elbow or wrist.

See Also: Glenohumeral Joint Anatomy

The examiner then brings the patient’s arm into horizontal adduction to the forward flexed position. At the same time, the examiner feels the humeral head slide posteriorly with his or her fingers. Cofield and Irving recommend medially rotating the forearm approximately 20° after the forward flexion then pushing the elbow posteriorly to enhance the effect of the test.

Similarly, the thumb may push the humeral head posteriorly as horizontal adduction in forward flexion is carried out to enhance the effect making the test similar to the posterior apprehension test.

What does a positive Norwood Stress Test mean?

A positive test is indicated if the humeral head slips posteriorly relative to the glenoid. Care must be taken because the test does not always cause apprehension before subluxation or dislocation. The patient confirms that the sensation felt is the same as that felt during activities. The arm is returned to the starting position, and the humeral head is felt to reduce. A clicking caused by the passage of the head over the glenoid rim may accompany either subluxation or reduction.

References & More

1. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
2. Norwood LA, Terry GC. Shoulder posterior subluxation. Am J Sports Med. 1984 Jan-Feb;12(1):25-30. doi: 10.1177/036354658401200104. PMID: 6703179. Pubmed
3. Cofield RH, Irving JF. Evaluation and classification of shoulder instability. With special reference to examination under anesthesia. Clin Orthop Relat Res. 1987 Oct;(223):32-43. PMID: 3308270. Pubmed
4. Physiopedia – Norwood Stress Test