Recurrent or traumatic tendency of the humeral head to translate anteriorly, often after dislocation or subluxation.
THE MSK CLINICAL STORY
The shoulder that remembered the last dislocation
A fictional teaching case. Follow the clues, enjoy the conversation, and make the decisions a thoughtful clinician would make—not an instant diagnosis from a single symptom.
Scene 01 · The patient walks in
A volleyball player hesitates before serving. His arm approaches abduction and external rotation, and his face says 'not again' before he says a word. He dislocated the shoulder last season.
A little clinic conversation
Player: 'It feels as though it might pop out.' Therapist: 'That feeling matters. We are not going to win a bravery contest with your shoulder today.'
Scene 02 · Follow the clues
Apprehension in abduction/external rotation after a dislocation supports a possible anterior instability pattern, but screen the joint and neurovascular status first.
Plot twist · What could fool us?
Pain in that position is not identical to apprehension; ask whether the patient fears redislocation. Check axillary nerve function after dislocation.
Choose your learning lens
Same clinical case, two ways to understand it. The complete examination and treatment guide is still available below.
In everyday words
Your shoulder may have become vulnerable to slipping out again after the first dislocation. We'll assess its stability and nerve function and rebuild control while considering specialist input where needed.
Scene 03 · The rehabilitation journey
Restore comfortable control → strengthen rotator cuff/scapular muscles → gradually expose the arm to sport-specific positions with confidence and objective control.
Immediately after a shoulder dislocation has been medically reduced, what must not be missed?
Choose one answer to reveal the explanation. No score, no pressure—just better clinical reasoning.
These cases teach reasoning; they do not provide a diagnosis for an individual patient. Always consider red flags, contraindications, comorbidities and local referral pathways.
Multidirectional/laxity-related patterns require separate assessment
Symptoms
Apprehension in vulnerable positions
Sense of slipping/giving way
Pain after instability event
Reduced confidence overhead
Clinical Signs
Apprehension in abduction/external rotation
Possible increased translation
Rotator cuff/scapular weakness
History of dislocation/subluxation
Red Flags & Referral Clues
Unreduced dislocation
Axillary nerve deficit
Vascular compromise
Associated fracture
Repeated episodes with major bone loss suspicion
Diagnostic Examination
How to perform the tests — step by step
Each test includes patient setup, therapist position, hand placement, exact performance, positive finding and clinical interpretation.
Apprehension Test
Assess anterior shoulder instability.
Patient position
Supine or sitting; shoulder abducted about 90° and elbow flexed.
Therapist position
Beside tested shoulder.
Hand placement
One hand controls forearm/wrist; the other supports shoulder as needed.
How to perform
1Slowly externally rotate the abducted shoulder.
2Do not force into pain or instability.
3Ask about apprehension rather than pain alone.
Positive sign
Distinct fear/apprehension of impending dislocation or subluxation.
Interpretation
Supports anterior instability.
Relocation Test
Confirm that posterior stabilization reduces apprehension.
Patient position
Supine in apprehension position.
Therapist position
Beside shoulder.
Hand placement
Apply posteriorly directed pressure over the humeral head.
How to perform
1Reproduce controlled apprehension position.
2Apply gentle posterior stabilization to humeral head.
3Reassess apprehension/symptoms.
Positive sign
Apprehension decreases with posteriorly directed stabilization.
Interpretation
Supports anterior instability when paired with apprehension test.
Differential Diagnosis
Rotator cuff tear
SLAP/labral pathology
Cervical radiculopathy
AC injury
Multidirectional instability
Investigations / Imaging
Radiographs after dislocation to assess alignment/fracture.
MRI/MR arthrogram or CT may be used for labral/bony injury depending specialist assessment.
Complete Rehabilitation Plan
From protection to full function
Phase 1 — Protection & Control
Restore comfortable ROM and cuff/scapular activation after acute instability.
What to do
Protect vulnerable abduction/ER range early
Pain-free ROM
Isometric cuff activation
Scapular control
Exercise dosage
ER/IR isometrics: 3–5 x 20–30 s
Scapular retraction/protraction control: 2–3 x 10–15
Progress when
Comfortable ADLs
Improving ROM without apprehension
Phase 2 — Dynamic Stability
Build cuff, scapular and proprioceptive control.
What to do
Progress resistance
Closed-chain perturbation
Rhythmic stabilization
Gradual ER exposure
Exercise dosage
Cuff/scapular strength: 3–4 x 8–15
Perturbation/control drills: 3–5 bouts of 20–45 s
Progress when
No instability episodes
Good control through increasing range
Phase 3 — Overhead / Contact Return
Restore high-speed and sport-specific stability.
What to do
Plyometric throwing/pressing
Overhead exposure
Contact preparation if relevant
Exercise dosage
2–3 high-level sessions/week with graded volume
Progress when
Full functional ROM
No apprehension during sport positions
Adequate strength and task-specific confidence
Manual Therapy — Role & Application
Avoid aggressive anterior glides in anterior instability.
Use manual therapy only for true secondary mobility deficits and with direction chosen to protect instability.
Dynamic stabilization is the priority.
Modalities — Use / Avoid
Ice may assist acute post-event pain/swelling.
Taping/bracing may improve confidence short term but is not a replacement for stabilization training.
Return / Discharge Criteria
No recurrent instability
Full controlled sport-specific ROM
Strong rotator cuff/scapular musculature
No apprehension in required positions
Contact/overhead drills completed
Common Clinical Mistakes
Treating pain but ignoring instability
Aggressive stretching into vulnerable ER
Using apprehension pain alone rather than true instability sensation
Clinical Pearls
Abduction + external rotation + fear of dislocation is the classic anterior instability clue.
Always check axillary nerve function after dislocation.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
