Shoulder Relocation Test | Shoulder Instability

[@arieladami8281]

You guys are amazing. Definitely helping me study for my PTA licensure exam that I take in 3 weeks! Thanks!

[@Physiotutors]

+ariel adami hey Ariel ! Good to hear ! Let us know how it went and good luck !👍🏼

[@ahmadbekdash4979]

not me watching before my exam in 2 hrs

[@Physiotutors]

Remember: you’re never alone

[@MAYTHARAPHIKO]

Thank you for all your Videos

[@Physiotutors]

No worries May, thank you for following!

[@armantaghizadeh5885]

U guys make quite good content, keep up

[@leftofcentre2021]

Love your videos but...Hegedus et al (2012) states that the relocation test can test for anterior instability when COMBINED with the apprehension test (sens 81%, spec 98%). He also describes the relocation test to be the most sensitive (52%) for SLAP tears - I am unable to find where, in that systematic review,you obtained the Sens 65% and spec 90% that you have quoted- have I missed something?? Keep up the great work - let me know if you are at all interested in having some of your videos translated into Ukrainian :)

[@Physiotutors]

again referring to table three in the article, although studies included showed significant heterogeneity

[@Physiotutors]

and yes, we would love to have subtitles in ukranian! you can start immediately

[@leftofcentre2021]

It would appear that another apology is in order....:)

[@samaagamal122]

all your videos were really helpful thanks

[@Physiotutors]

Happy to hear Samaa and thank you for subscribing!

[@hosamelsayedorthotube7940]

Thanks for nice helpful video

[@physioweng]

Very well explained, hats off!

[@Physiotutors]

+The Humming Boy thx!

[@aqsairfan9799]

you are amazing

[@hendrikklein7948]

Nice explanation

[@Physiotutors]

Thanks Hendrik, glad you like it!

[@2007dodi]

I learned to apply AP force!? So how it goes!? Whose right?

[@Physiotutors]

A posterior glide is the same as AP glide

[@robbiegraaskamp9673]

top man

[@syedadurenajafnaqvi6196]

very well explained .Thanks!

[@jasonmorris4719]

Magee shows, Apprehension -> P/A Relocation -> A/P Relocation -> Release . It gets a little confusing in their text as they have about 20 different interpretations listed. Does the following interpretation seem correct? - What I have gathered: Apprehension: P! = Impingement Apprehension = Anterior Instability Relocations: IF P! A/P = Posterior Impingement (secondary or primary?) IF P! P/A = Anterior Impingement If Apprehension Either Direction = instability ? Release: ?

[@Physiotutors]

The way we show it is how it is officially performed. Apprehension, then you do the AP glide to glide the head of the humerus into posterior direction, then release to reconfirm apprehension. It would actually (biomechanically) make even more sense to do horizontal abduction in 90° of abduction to bring the humeral head even more anterior. In general and what is validated the Apprehension and follow-up tests (Relocation, Release) are designed to test (passive) anterior instability of the shoulder. The test is positive for "apprehension" by the patient, as the patient feels that his shoulder might (sub)luxate anteriorly. Cools et al. (2008) came up with the idea of anterior pain --> subacromial/external impingement and posterior pain -->internal impingement. However, this has never been validated and is just extra info we wanted to provide.

[@mairanoor3247]

my Father fell from. bike and hes gas pain in shoulder.... I am physiotherapy student... he asks me to assess snd i am confused... plz help me how should i assess him.... will you help me diagnosing me

[@chrisbreezybykushal5641]

How will I know that I’m applying the proper relocation force ?

[@Physiotutors]

That's something that is hard to teach with videos. Has to be a firm but not crazy load. Would say maybe 5kg

[@chrisbreezybykushal5641]

Thanx a lot buddy

[@ragalz4764]

So it's for instability or impingement?

[@Physiotutors]

Instability The „impingement“ hypothesis has largely been rejected Check the myth busting video on impingement we recently published

[@mishademidov6451]

Sensitivity rules out the diagnosis and specifisity rules in? Am i correct anybody?

[@Physiotutors]

Yes, that's the SNNOut and SPPIn rule.

[@sttvoyager1727]

@@Physiotutors you guys are sharp! Doctor David PT PHD...cheers!

[@JoeJonsenMusic]

Isn't it a primary impingment when the relocation test is positiv because the cause for it is between the acromion and humerushead ? Giving a pressure for moving the head posterior from the glenoid releases the stress between acromion and humerushead or not ?

[@JoeJonsenMusic]

instead of a secundary impingment*

[@Physiotutors]

Primary means due to bony abnormality for example and independent of the arthrokinematic position of the humeral head. So easing the pain in a positive relocation test means that you are altering the arthokinematic position of the humeral head and thus you could rather think of a secondary impingement. This is how Cools et al. (2008) suggest it in their algorithm, but be aware that this is just an algorithm based on clinical reasoning and not validated. Now that we're 10 years further, the impingement theory has been mainly rejected and we have learned that orthopedic tests for the shoulder are mostly not specific enough to blame a certain structure.

[@emogilner9]

not Osteo-Kinematics of the GH joint?

[@Physiotutors]

Hi Eylon, what do you mean?

[@kevinmontoya7036]

what test I can do to differentiate greater instability or minor?

[@Physiotutors]

You might wanna do the Load-and-Shift test. Still difficult thought to do that reliably.

[@ebtihal-3437]

if the test is negative what is it dependent on ?

[@Physiotutors]

A negative test means that you CANNOT ease the patient's pain or apprehension by PA pressure, which centers the humeral head in the glenoid again. Something else but anterior instability is probably the reason for shoulder pain/complaints in this patient. In comparison, If a patient has anterior instability, they are afraid that their humeral head will dislocate in an externally rotated position. If you give PA pressure, it eases their pain or feeling of subluxation. (test = positive)

[@ebtihal-3437]

Physiotutors so if test is negative this means that impingement due to primary or secondary cause? actually I am confused with this point

[@Physiotutors]

According to the algorithm of Cools et al. (2008) the relocation test is used for impingement rather than for instability. The underlying theory of it is to distinguish between primary and secondary (impingement due to humeral head position) impingement. With the test you are altering the humeral head position, so if it is positive --> secondary impingement, if it is negative --> primary impingement, because in this case the impingement is due to bony changes in the acromion for example which cannot be altered by the humeral head position.

[@ebtihal-3437]

Got it .thanks for clarification

[@林治均-f4s]

so if the test is positive, that mean the apprehension or pain is decreased. and we can know that the patient may have anterior instability right? I'm not good at english, and the meaning of positive and negative here really confuses me......

[@eidmuhammad5777]

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