Shoulder Apprehension - Sensation of Instability

shoulder apprehenson
Shoulder apprehension is the sensation your shoulder will come out of socket.. BJI / Blue Jean Images / Getty Images

A shoulder dislocation is an injury that occurs when the ball of the ball-and-socket shoulder joint comes out of position.  In most people who dislocate their shoulder for the first time, someone has to reset, or reduce, the shoulder to place it back in proper position.  In people who have dislocated their shoulder many times, often they can reposition the joint on their own.

Examination of a Shoulder Dislocation

Examining a patient who has had a suspected shoulder dislocation is an important step for your orthopedic surgeon.

  Among the tests commonly performed is a test to detect for shoulder apprehension.  In order to perform this test, your doctor will position your arm in a position that is most likely to cause the ball to begin to shift out of the socket.

When the ball starts to shift out of the socket, most patients can detect this sensation that they are about to feel their shoulder dislocate.  This feeling is called apprehension, and is a sign that the shoulder is unstable, and repeat dislocation is a concern.

Position of Apprehension

The most common type of shoulder dislocation occurs when the ball is pushed out the front of the shoulder socket, called an anterior dislocation.  The arm is usually in a position of abduction (held away from the side) and external rotation (hand pointing upwards).  This image on this page shows an examiner holding the shoulder in this position of abduction and external rotation.

  Often this test is performed with the patient lying down on the examination table. 

A positive apprehension test occurs when your doctor holds the arm in this position and you have a sensation that the shoulder is about to come out of socket.

Relocation Test

A relocation test can also be performed.  In this situation, your doctor will press down over the front of your shoulder.

  When the patient begins to complain of a sensation of apprehension, the examiner presses down on the front of the shoulder--trying to push the ball back into the socket.  In this case, a positive test result occurs when the relocation maneuver causes relief from the sensation of apprehension.

Treatment of Shoulder Dislocations

Patients with positive tests for a shoulder dislocation will usually have an MRI test to evaluate the anatomy around the shoulder to determine why the shoulder is coming out of the socket.  Typically, patients have a tear of their labrum (most often a Bankart tear) and a Hill-Sachs lesion.  These are injuries that occur when the ball comes out of the shoulder socket.

Treatment of a dislocation can either be surgical or non-surgical.  Non-surgical treatment is usually attempted for individuals who have a lower chance of repeat dislocation.   These patients are usually older (patients younger than 25 have a very high risk of repeat dislocation), and don't play contact sports.

  Surgery is typically performed on younger patients, or on people who have had more than one dislocation.  There is always controversy as to whether young athletes should have surgery after a first-time dislocation.  Some surgeons argue that non-surgical treatment should at least be tried once.  Others believe that surgery is better in individuals with a high chance of repeat dislocation.


Lintner SA and Speer KP "Traumatic Anterior Glenohumeral Instability: The Role of Arthroscopy" J Am Acad Orthop Surg October 1997 ; 5:233-239.

Continue Reading