Anterior Apprehension Test | Steps, Indications and More

Apprehension sign or crank test is a clinical test applied in the diagnosis of anterior instability of the shoulder known as the Anterior Apprehension Test. The use of this test is especially important in conditions involving shoulder dislocations or subluxations, in athletes or persons with a history of episodes of shoulder dislocation.

Indication for Anterior Apprehension Test

The Anterior Apprehension Test is indicated for patients who present with:

• Previous experience of shoulder dislocations or subluxations.
• Patient’s report of shoulder dissatisfaction when the limb is placed in the adequate position, that is, A & E.
• Difficulty in carrying out chores that involve overhead use of the arm or experiences shoulder pains during these activities.
• Possible clinical diagnosis was anterior labral tear or Bankart lesion.
• The way that physiotherapists conduct this test

Steps to Perform Anterior Apprehension Test

The Anterior Apprehension Test is applied by physiotherapists for evaluating the anterior shoulder stability. The steps involved are:

1. Positioning the Patient: The position of the patient is either seated or lying flat on the back. The positioned change described above is utilized more frequently for better control and visualization.
2. Arm Placement: The position used by the physiotherapist is 90 degrees of abduction of the patient’s arm and 90 degree elbow flexion.
3. External Rotation: The patient then takes a prone position on the treatment table and the physiotherapist gently places the forearm of the affected limb on the table then externally rotates the shoulder without observing the patient’s face for signs of discomfort.

Assessment Outcome for Anterior Apprehension Test

Positive Test: The positive test is marked when the patient has an appearance of apprehension or in other words, when the patient looks anxious or fearful or else is uncomfortable, it can be concluded that the patient has a possible anterior shoulder instability. The patient may object to further external rotation, or indicate a feeling that the shoulder may pop out.

Negative Test: Specifically, lack of concern or anxiety that surrounds an unstable shoulder leads to a generalized conclusion that anterior shoulder instability is not likely.

Differential Diagnosis By Anterior Apprehension Test

The Anterior Apprehension Test helps differentiate anterior shoulder instability from other shoulder pathologies such as:

• Rotator cuff injuries
• Glenohumeral joint arthritis
• Labral tears (non-Bankart lesions)
• Biceps tendon pathology

Thus, this test can be used to differentiate between the cause of shoulder pain and instability by specifically provoking anterior instability. make the informed diagnosis to plan he treatment plan. We have physio CPD courses that is Recognize signs and symptoms of common shoulder disorders including rotator cuff pathology, SLAP tears, adhesive capsulitis, instability, impingement, arthritis, and overuse.  Enroll to the master call and  become CPD certified physiotherapist with our advance shoulder rehabilitation protocol  

Related Special Tests for Shoulder Joint

Other tests related to shoulder instability and associated conditions include

• Another test performed was the Relocation Test (Jobe’s Relocation Test).
• Aski 2007, Anterior Release Test (Surprise Test)
• Load and Shift Test
• Sulcus Sign Test
• Crank Test

Advance Researches on Anterior Apprehension Test

Physiotherapy is a unique area of research that has undergone the latest scientific evidences to adopt as its practice for handling various related disorders.

The systematic analysis of the scientifically grounded literature underlined the necessity of using the Anterior Apprehension Test concurrently with the other clinical tests and imaging studies to diagnose shoulder instability. Research supports the use of a comprehensive rehabilitation program that includes:

• Exercises aimed at the rotator cuff muscles and scapulothoracic muscles.
• Stability exercises directed towards confirmation of proprioceptive training regarding shoulders.
• Application of manual mobilisation or manipulation in an attempt to eliminate any joint limitation.
• Discharge planning; informing the patient on how to avoid repeat dislocations.
   

Present research activities are primarily directed at enhancing the diagnostic accuracy and treatment effectiveness by means of highly sophisticated tools and the introduction of programmes for standardized rehabilitation. It is imperative to follow the current best practices in EBP and employ the use of the multimodal approach to help improve patients’ shoulder stability management.

In terms of the continual care, the patient’s self-report data should be employed in order to evaluate the effectiveness of the treatments and modify the therapy consequently – this is known as patient-reported outcome measures (PROMs). Such an approach allows focusing on individual needs and the results achieved by each particular patient.