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Examination of the Shoulder
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Sulcus sign: This test is used to assess for laxity of the rotator cuff interval. With the patient standing, position their arm at their side, pull longitudinal traction downward. The test is considered positive if there is a sulcus or dimpling of the skin that develops inferior to the acromion. Tzannes et al., reported a sensitivity of 72% and specificity of 85% with more than 1 cm of inferior translation, and a sensitivity of 28% and specificity of 97% with more than 2 cm of translation.14
Examination of Pediatric Shoulder
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
With the patient standing, the arm by the side, the patient’s forearm is held firmly, and the arm is pulled distally. The presence of a sulcus below the acromion process indicates inferior instability. The sulcus sign with a sensation of subluxation is more clinically significant.7
Physical examination of the shoulder
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Florian B. Imhoff, Andreas Voss
The sulcus test (sulcus sign) examines the laxity of the shoulder joint in an inferior direction. An axial pull is triggered by the relaxed hanging arm, while the other hand of the examiner fixes the patient's scapula. If there is an increased inferior translation, a retraction of the skin is observed lateral to the acromion, which can be graded according to Altchek33: Grade 0: 0–1 cmGrade 1: 1–2 cmGrade 2: >2 cm
Home-based exercise therapy for treating shoulder instability in patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders. A randomized trial
Published in Disability and Rehabilitation, 2023
Valentien Spanhove, Inge De Wandele, Fransiska Malfait, Patrick Calders, Ann Cools
To be eligible for this study, patients had to be diagnosed with hEDS or generalized HSD according to the 2017 classification of the international EDS consortium [1,2]. In addition, patients had to be between 18 and 65 years old and have MDI confirmed by clinical examination. The clinical exam was performed by two physical therapists with knowledge of hEDS, HSD, and MDI. The diagnosis of MDI was confirmed when (1) patients reported symptoms of shoulder instability in daily life (e.g., recurrent subluxations) without a traumatic onset; (2) patients scored positive on shoulder laxity and instability tests (i.e., sulcus sign, anterior and posterior load and shift, posterior jerk, Gagey hyperabduction test, passive and active external rotation in supine, apprehension, and relocation test) in at least two directions [16,17,21]; (3) patients had shoulder pain for at least three months prior to the study. Pregnant women were excluded from the study. Only women were recruited for this study, given the large predominance of joint hypermobility conditions in females [22]. Participants were allowed to continue their usual therapy (medication and physical therapy), but were asked not to start any new treatment during the study period.
Comprehensive review of the physical exam for glenohumeral instability
Published in The Physician and Sportsmedicine, 2020
Brandon T. Goldenberg, Lucca Lacheta, Samuel I. Rosenberg, W. Jeffrey Grantham, Mitchell I. Kennedy, Peter J. Millett
The inferior apprehension test assesses inferior joint laxity and detects inferior glenohumeral instability. The patient’s arm is abducted 90° and his or her hand is placed on the examiner’s shoulder. The examiner then applies gentle downward pressure with both hands on the proximal humerus (Figure 10). A positive test is indicated by the presence of apprehension. Due to the difficulty in estimating the amount of translation, this test should be performed bilaterally. It should be noted that this test offers no advantage over the later mentioned sulcus sign in the evaluation of inferior instability [32].
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
Pneumothorax can be identified on CXR as a visceral line between lung and chest wall and the absence of lung markings beyond. Pneumothorax may be missed in high-risk acutely unwell patients, for example in those who can only tolerate a supine or semi-erect CXR. The deep sulcus sign on supine CXR describes the phenomenon of pleural air collecting in the anterior costophrenic sulcus, with resultant hyperlucency[7]. It is estimated that additional subtle information on CXR, such as the deep sulcus sign, may identify pneumothorax on 24% of previously missed occult pneumothoraces[8].