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Special Test

Shoulder Anterior Release Test

The Shoulder Anterior Release Test or Surprise Test is another test for anterior instability of the shoulder that depends on the apprehension feeling. It’s also called surprise test.

How to perform the Shoulder Anterior Release Test?

The patient lies in the supine position with the shoulder at 90 degrees of abduction and the elbow flexed to 90 degrees. The clinician passively moves the patient’s shoulder into external rotation while applying a posteriorly directed force to the head of the humerus. At the point of end-range external rotation, the clinician quickly releases the posterior force and notes whether the patient displays any sign of apprehension.

The resulting pain from this shoulder anterior release test procedure may be caused by anterior shoulder instability, a labral lesion (Bankart lesion or SLAP lesion – superior labrum, anterior posterior), or bicipital peritenonitis or tendinosus. Most commonly it is related to anterior instability because the pain is temporarily produced by the anterior translation. It has also been reported to cause pain in older patients with rotator cuff pathology and no instability.

See Also: Shoulder Apprehension Test
Shoulder Anterior Release Test
Shoulder Anterior Release Test

This release maneuver should be done with care because it often causes apprehension and distrust on the part of the patient, and it could cause a dislocation, especially in patients who have had recurrent dislocations. For most patients, therefore, when the relocation test is done, lateral rotation should be released before the posterior stress is released.

In a study by Lo et al which assessed the validity of the apprehension, relocation, and surprise tests as predictors of anterior shoulder instability, for those subjects who had a feeling of apprehension on all three tests, the mean positive and negative predictive values were 93.6% and 71.9%, respectively.

The surprise test was the single most accurate test with a sensitivity 63.89% and specificity 98.91%.

An improvement in the feeling of apprehension or pain with the relocation test added little to the value of the tests. The results of this study would suggest that a positive instability examination on all three tests is highly specific and predictive of traumatic anterior G-H instability.

References & More

  1. Gross ML, Distefano MC. Anterior release test. A new test for occult shoulder instability. Clin Orthop Relat Res. 1997 Jun;(339):105-8. doi: 10.1097/00003086-199706000-00014. PMID: 9186207.
  2. Lo IK, Nonweiler B, Woolfrey M, Litchfield R, Kirkley A. An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability. Am J Sports Med. 2004 Mar;32(2):301-7. doi: 10.1177/0095399703258690. PMID: 14977651.
  3. Kelley MJ. Evaluation of the shoulder. In: Kelley MJ, Clark WA, eds. Orthopedic Therapy of the Shoulder. Philadelphia: JB Lippincott; 1995.
  4. Orthopedic Physical Assessment by David J. Magee, 7th Edition.
  5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
  6. Clinical Tests for the Musculoskeletal System 3rd Ed. Book.
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