Porcellini Test

The Porcellini Test is designed to evaluate posterior shoulder instability and identify posterior labral tears.

The clinical significance of posterior shoulder instability cannot be understated, as it accounts for approximately 2-10% of all shoulder instability cases. While less common than anterior instability, its correct diagnosis is essential for appropriate patient management and treatment planning. The Porcellini Test, developed by Giuseppe Porcellini and colleagues, offers clinicians a reliable method to assess this condition.

How to perform the Porcellini Test?

The examination begins with the patient in a standing position while the examiner positions is behind the patient. The patient’s arm should be positioned in 90 degrees of forward flexion, with 10 to 15 degrees of abduction, and maximal medial rotation. This positioning is somewhat similar to the arm position used in the O’Brien test, though the clinical focus differs significantly.

The test consists of two distinct phases that allow for comparison:

In the first phase, the examiner stabilizes the patient’s scapula with one hand. The patient is then instructed to elevate their arm while the examiner applies downward resistance. During this movement, the examiner should carefully note both the presence of pain and the level of strength demonstrated by the patient.

The second phase maintains the same initial patient positioning but introduces a crucial modification. The examiner places their thumb just lateral to the posterior glenohumeral joint line while still stabilizing the scapula. This thumb placement serves to stabilize the posterior humeral head and provides an anterior force that prevents posterior humeral head subluxation. The patient then performs the same elevation movement against resistance.

See Also: Shoulder SLAP Lesion

What is a positive Porcellini Test?

A positive Porcellini Test is indicated when the patient experiences a reduction in pain during the second phase of testing compared to the first phase. This pain reduction may or may not be accompanied by changes in strength. The underlying principle suggests that by preventing posterior subluxation of the humeral head, symptoms associated with posterior instability or labral pathology should diminish.

Reliability & Validity

This Porcellini test has a high accuracy for posterior labral tears with sensitivity of 100 %, specificity of 99.3 %, the positive and negative predictive values of 92.6 and 100 %, respectively. Also, it had superior accuracy results than every other test. The interexaminer reliability for all test results was found to be >0.80.

In their Comparative Study, Morey and his colleagues propose “Porcellini test” as a simple, accurate, reproducible, and reliable test for the preoperative diagnosis of posterior labral tears of shoulder.

References & More

1. Morey VM, Singh H, Paladini P, Merolla G, Phadke V, Porcellini G. The Porcellini test: a novel test for accurate diagnosis of posterior labral tears of the shoulder: comparative analysis with the established tests. Musculoskelet Surg. 2016 Dec;100(3):199-205. doi: 10.1007/s12306-016-0422-3. Epub 2016 Sep 3. PMID: 27591779. Pubmed
2. Orthopedic Physical Assessment by David J. Magee, 7th Edition.