Shoulder
Instability
Evidence: confirmed
Sulcus Sign Special Test
Orthopedic Physical Examination & Clinical Assessment Guide
What is it used for?
- Diagnosing Multidirectional Instability (MDI) and Inferior Laxity.
How to Perform
- Action: Pull the arm downward (traction) at the elbow.
- Observation: Look for a depression (sulcus) below the acromion.
Interpretation of Results
- Positive Test: A visible sulcus >1cm.
Diagnostic Accuracy
- Sensitivity: 28%
- Specificity: 97%
Clinical Context & Limitations
The Sulcus Sign should be considered as one component of a comprehensive musculoskeletal assessment. No single special test has perfect diagnostic accuracy; thus, clinical decision-making should integrate test results with patient-reported symptoms, mechanism of injury, functional impairment, and relevant imaging.
Clinicians should be aware of potential false-positive results in patients with pain sensitisation, muscle guarding, or poor relaxation. For the Shoulder region, combining the Sulcus Sign with complementary examination tests significantly improves overall diagnostic confidence.
References
- Magee, D. J. (2021). Orthopedic Physical Assessment.
