Diagnosing a Bony Bankart lesion starts with a detailed patient history, but it’s the physical exam that often reveals the underlying instability. By applying specific maneuvers, clinicians can reproduce symptoms and detect signs of structural damage in the shoulder joint. In this article, we explore the most reliable special tests used to evaluate patients for Bony Bankart lesions, with a focus on shoulder apprehension, relocation maneuvers, and the sulcus sign.
1. The Importance of Physical Examination
Before imaging, a skilled clinical evaluation helps:
- Differentiate bony vs. soft tissue causes of instability
- Assess the degree of shoulder laxity
- Determine which movements provoke symptoms
- Establish the need for further imaging or surgical consultation
When performed systematically, these tests provide valuable insight into the functional stability of the glenohumeral joint.
2. Apprehension Test
2.1. Purpose
To detect anterior instability, particularly when the arm is positioned similarly to the mechanism of injury.
2.2. How It’s Done
- Patient lies supine or sits upright
- Examiner abducts the arm to 90 degrees and gently externally rotates the shoulder
- A positive test is indicated by fear, resistance, or the sensation that the shoulder is about to “pop out”
2.3. Interpretation
- Positive in cases of anterior labral tears or Bony Bankart lesions
- Indicates disruption of the anterior stabilizers—especially the labrum and glenoid rim
3. Relocation Test
3.1. Purpose
Used in conjunction with the apprehension test to confirm anterior instability.
3.2. How It’s Done
- Performed immediately after a positive apprehension test
- Examiner applies posterior pressure on the humeral head while maintaining external rotation
- A positive result is the relief of discomfort or apprehension
3.3. Significance
- Strongly correlates with anterior capsulolabral injuries
- Helps distinguish between true instability and shoulder stiffness
4. Sulcus Sign
4.1. Purpose
Assesses inferior glenohumeral laxity or capsular redundancy.
4.2. How It’s Done
- Patient seated with arm relaxed at the side
- Examiner pulls gently downward on the elbow or wrist
- A visible “sulcus” or gap between the acromion and humeral head indicates a positive sign
4.3. Clinical Relevance
- Suggests multidirectional instability, often accompanying anterior lesions
- A positive sulcus sign does not confirm a Bony Bankart lesion on its own, but it may highlight the need for comprehensive imaging
5. Load and Shift Test
5.1. Objective
Measures the translational movement of the humeral head over the glenoid.
5.2. Execution
- Patient seated; examiner stabilizes the scapula and grasps the humeral head
- Gently applies anterior and posterior pressure while “loading” the joint
- Excessive translation (graded mild to severe) indicates capsular or bony pathology
5.3. Application
- Particularly useful in evaluating functional instability
- Can differentiate between a loose capsule and structural defects like a Bony Bankart
6. Additional Tests Sometimes Used
6.1. Jobe Relocation/Release Test
- Amplifies the relocation test by suddenly removing posterior pressure
- Sudden return of pain or apprehension confirms instability
6.2. O’Brien Test
- Primarily for SLAP lesions but may reproduce symptoms in patients with anterior labral pathology
7. Limitations of Physical Testing
- Acute pain or muscle guarding can interfere with results
- Difficult to assess in patients with high anxiety or limited range of motion
- Best used in combination with imaging for diagnostic accuracy
Summary of Key Tests
| Test | Purpose | Positive Result |
| Apprehension | Detect anterior instability | Fear or resistance during external rotation |
| Relocation | Confirm instability | Relief of pain with posterior pressure |
| Sulcus Sign | Inferior laxity | Visible gap below acromion |
| Load and Shift | Translation assessment | Excess movement of humeral head |
Frequently Asked Questions
1. Can these tests confirm a Bony Bankart lesion on their own?
No. While they indicate instability, imaging (CT or MRI) is necessary to confirm bone loss and assess fragment position.
2. Are these tests painful?
They may provoke discomfort or fear of dislocation, but they are not harmful when performed carefully.
3. What if all tests are negative, but instability is still suspected?
Imaging and further diagnostic tools may still be warranted, especially in high-risk individuals or athletes.
4. Is one test more accurate than the others?
The apprehension-relocation combination is among the most sensitive for anterior instability.
5. Do these tests apply to posterior instability?
No. Different exams (e.g., jerk test, posterior apprehension) are needed for posterior or multidirectional instability.
