Posterior Apprehension Test

The Posterior Apprehension Test is an actual clinical examination method applied in order to determine a posterior shoulder instability or dislocation. This test also aids in determining whether the posterior part of the shoulder including, the posterior labrum or posterior capsule, is injured or if the individual is more prone to posterior shoulder dislocation.

Indication for the Posterior Apprehension Test

The Posterior Apprehension Test is indicated for patients who present with symptoms suggestive of posterior shoulder instability, such as:

• Previous episodes of shoulder dislocation or subluxation, especially of the posterior type.
• Pain or discomfort with activities that put horizontal stress on the shoulder or that involve internal rotation.
• Spontaneous feeling that the shoulder is ‘slipping’ or ‘giving-way’.
• Disequilibrium of the shoulder girdle connections or mechanically unsound shoulder joint.

How to Perform the Posterior Apprehension Test

To perform the Posterior Apprehension Test, the physiotherapist follows these steps:

1. Positioning: A patient is lying on a back on top of an examination table.
2. Starting Position: The physiotherapist restrains the patient’s arm in 90 degrees of shoulder flexion and internal rotation and with the elbow flexed. 
3. Posterior Force Application: The physiotherapist places his/her hand on the proximal humeral shaft and directs a force towards the patients back posteriorly along the long axis of the humerus.
4. Observation and Palpation: The physiotherapist then follows the patient’s response and using the other hand compresses the back of the shoulder as an indicator of apprehensiveness or instability.

Assessment Outcome of Posterior Apprehension Test

• Positive Test: Due to the ‘posterior force’, the patient feels apprehensive, painful or may experience instability that may be a sign of posterior instability or dislocation of the shoulder joint.
• Negative Test: That is why there is no fear, pain or instability in the posterior shoulder which implies that the patient has relatively minor posterior instability.

Differential Diagnosis with Posterior Apprehension Test

The Posterior Apprehension Test is useful for differentiating posterior shoulder instability from other shoulder pathologies, such as:

• Preferable shoulder or anterior instability or dislocation.
• Rotator cuff tears.
• Other ones are labral tears such as Bankart for anterior instability and reverse Bankart for posterior.
• Adhesive capsulitis (frozen shoulder).
• Acromioclavicular joint pathology.

Related Posterior Apprehension Tests

• Jerk Test
• Load and Shift Test (Posterior)
• Kim Test
• Sulcus Sign
• Posterior Drawer Test
• The Apprehension Test is used for diagnosing anterior instability of the shoulder.
• Relocation Test

Evidence-Based Physiotherapy

The findings of current research reveal that the PAT is a valid and reliable clinical test that can be incorporated in an evaluation of the posterior shoulder instability. Thus, its use together with other clinical examinations and instrumental investigations including MRI or CT arthrography has a higher efficiency.

Perhaps future directions regarding physiotherapy could involve the ongoing enhancements of diagnostic methods and innovations in imaging, and enhancement or development of more effective rehabilitation regimes for patients with posterior shoulder instability. Much stress is also laid on the development of programmes tailored for each patient which should include exercises aimed at strengthening muscles’ resistance, proprioceptive exercises, exercises that target scapular stabilizers, manual therapy and finally, educating the patient on activities to avoid and changes to be made at the workplace.

The preliminary findings indicate that the nonsurgical treatment employing structured physiotherapy can be beneficial for the majority of the patients with the posterior shoulder instability. However, if the dislocation is recurrent or if there is significant structural damage, one might have to bother the patient with some reconstructive surgeries like the posterior labral repair or capsular shift surgery. Further investigation is imperative in developing a set of care guidelines that increase the efficiency of non-surgical and surgical interventions in an attempt to modify patient experiences through informed care practices.