Anterior Apprehension Test: How to Check for Shoulder Instability

The Anterior Apprehension Test (or Sign) is a crucial special test for the shoulder, used by physiotherapists to assess for anterior glenohumeral instability. Click the sections below for details on how to perform it and what the results mean.

1. Purpose

The primary purpose of the Anterior Apprehension Test is to **test for** anterior glenohumeral instability. It is designed to provoke the symptoms of instability by placing the shoulder in the "at-risk" position (abduction and external rotation), which stresses the anterior capsule, glenohumeral ligaments, and anterior labrum.

2. How to Perform

1. The patient is positioned in supine (lying on their back) and relaxed.
2. The examiner stands beside the affected shoulder.
3. The examiner passively brings the patient's shoulder into 90 degrees of abduction.
4. The examiner flexes the patient's elbow to 90 degrees.
5. While supporting the arm, the examiner slowly and gently applies passive external rotation to the shoulder.
6. The examiner watches the patient's face and asks if they feel any pain or, more importantly, any sense of apprehension.

3. Positive & Negative Sign

Positive Sign (Test is POSITIVE):
A positive test (indicating instability) is:

• Reproduction of the patient's feeling of apprehension or fear that the shoulder is about to "pop out" or dislocate.
• The patient may also report pain, but apprehension is the key finding.
• The patient may physically resist further external rotation.

Negative Sign (Test is NEGATIVE):
A negative test is the absence of apprehension or pain as the shoulder is brought into full external rotation.