The Painful Anterior Apprehension Test – an Indication of Occult Shoulder Instability
https://doi.org/10.5704/MOJ.2203.014
- Author:
Law GW
1
;
Ng ZD
1
;
Tan JH
1
;
Wong KLF
2
;
Ng YH
1
Author Information
1. Department of Orthopaedic Surgery, National University Health System, Singapore
2. Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
- Publication Type:Journal Article
- Keywords:
painful apprehension test, shoulder instability, synovitis, dislocation
- From:Malaysian Orthopaedic Journal
2022;16(No.1):97-102
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: To evaluate the clinical relevance of the
painful anterior apprehension test in shoulder instability.
Materials and methods: We performed a retrospective
study of 155 patients that underwent arthroscopic anterior
Bankart repair between 2014–2016. Exclusion criteria were
previous ipsilateral shoulder surgery, bony Bankart lesions,
glenohumeral osteoarthritis and concomitant surgery
involving rotator cuff tears, biceps tendon pathology and
superior labrum from anterior to posterior (SLAP) lesions.
The study cohort was divided into three groups:
apprehension test with apprehension only, apprehension test
with pain only, and apprehension test with both apprehension
and pain. Patient demographics, clinical characteristics,
radiological imaging, arthroscopy findings and surgical
outcomes (Constant, American Shoulder and Elbow
Surgeons (ASES), SF-36 scores) were evaluated.
Results: A total of 115 (74.2%) had apprehension only, 26
(16.8%) had pain only and 14 (9.0%) had pain and
apprehension with the apprehension test. Univariate analysis
showed significant differences between the groups in
patients with traumatic shoulder dislocation (p=0.028),
patients presenting with pain (p=0.014) and patients
presenting with recurrent dislocations (p=0.046). Patients
with a purely painful apprehension test were more likely to
have a traumatic shoulder dislocation, more likely to present
only with pain, and less likely to present with recurrent
shoulder dislocations. Multivariate analysis showed that
none of these factors alone were significant as single
predictors for shoulder instability. All three groups were
otherwise similar in patient profile, MRI and arthroscopic
assessments, and clinical outcomes of surgery. Excellent
clinical outcomes were achieved in all groups with no
difference in pre-operative and post-operative scores across
all groups at all time points.
Conclusion: The painful apprehension test may suggest
underlying shoulder instability.
- Full text:16.2022my1231.pdf
