Which combination of shoulder examination maneuvers is most specific for anterior shoulder instability?

• A. Yergason’s test and Speeds test
• B. Anterior apprehension test with a positive relocation test
• C. Hawkins-Kennedy and Neer
• D. Cross-body adduction test

Answer: (B)

Stability of the glenohumeral joint is best assessed by tests that both provoke instability and confirm it by showing a change when the suspected pathologic mechanism is addressed. The anterior apprehension test places the arm in a position where the humeral head is most likely to translate anteriorly if there is laxity or a history of dislocation. If the patient becomes fearful or tense about the possibility of dislocation, that signs supports anterior instability—but on its own, a positive apprehension can reflect other pain factors too, so it isn’t perfectly specific.

Adding the relocation maneuver increases specificity. By applying a posteriorly directed force to the humeral head while maintaining the same position, you reduce anterior translation. If the patient’s apprehension and symptoms lessen with the relocation, it strongly implicates true anterior instability rather than a non-instability source of pain. This combination directly tests the mechanism of instability and shows a reversible relief, which is what specificity hinges on.

The other tests assess different problems. Yergason’s and Speeds tests mainly evaluate biceps tendon pathology and SLAP lesions rather than instability. Hawkins-Kennedy and Neer target subacromial impingement. The cross-body adduction test stresses the AC joint and can reproduce AC pathology or impingement but does not isolate anterior translation of the humeral head.