Sulcus Sign (Inferior Glenohumeral Instability)

Purpose: To determine if there is a presence of inferior glenohumeral instability and/or laxity (1).

Patient position: Standing or Sitting upright with back unsupported and with affected arm relaxed by the side.

Examiner position: Standing beside the patient’s affected side.

Procedure: Grasp the patient’s affected side arm, around the elbow (at the bicondylar axis of the humerus) and gently pull the arm distally through the long axis of the humerus (1).

Outcome: This test(Sulcus Sign) is positive if the patient has a greater dip/gap/sulcus below the acromion tip on the affected side compared to the contralateral shoulder (2, 3). The patient may also have a feeling of subluxation while the arm is pulled distally.

Reference:

1. Wilk KE, Andrews JR, Arrigo CA. The physical examination of the glenohumeral joint: emphasis on the stabilizing structures. Journal of Orthopaedic & Sports Physical Therapy. 1997;25(6):380-9.
2. Foster C. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. The Journal of bone and joint surgery American volume. 1980;62(6):897-908.
3. Neer CS, Foster CR. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: a preliminary report. JBJS. 2001;83(10):1586.