Purpose of Bony Apprehension Test: To test if bony lesions are contributing to the cause of anterior instability of the glenohumeral joint (1). The bony lesions one should consider in this context are an osseous glenoid deficiency i.e., a bony bankart lesion of at least 25% of the glenoid and/or an engaging hill-sachs lesion of at least 2 cm in engagement length (1).

Patient position: Sitting (1).

Examiner position: Stand facing the patient’s affected side.

Procedure: Gently flex the patient’s affected side elbow joint to 90 degrees and abduct the affected shoulder joint to 45 degrees (or less as tolerated), maintaining the humerus in neutral rotation. Gently perform lateral rotation of the patient’s shoulder joint up to 45 degrees (or less as tolerated) (1, 2).

Outcome: This test is positive if the patient feels apprehensive of subluxing or dislocating the shoulder joint (1).

Reference:

1. Bushnell BD, Creighton RA, Herring MM. The bony apprehension test for instability of the shoulder: a prospective pilot analysis. Arthroscopy: the journal of arthroscopic & related surgery: official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2008;24(9):974-82.
2. Lizzio VA, Meta F, Fidai M, Makhni EC. Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability. Current Reviews in Musculoskeletal Medicine. 2017;10(4):434-41.