Understanding the Sulcus Sign Assessment
The sulcus test is used to assess the glenohumeral joint for inferior instability, due to laxity of the superior glenohumeral ligament and coracohumeral ligament.It was first described by Neer and Foster in 1980 to examine multidirectional instability
Watch How It's Done
How do I start?
Patient is sitting or standing with the arm at the side.
What happens?
This test can be performed with the patient sitting, standing, or in a supine position with their shoulder in neutral (0 degrees rotation). The examiner then pulls the distal part of the humerus in a caudal direction. However, the sitting position with arms by the side is considered to provide more reliable results as suggested by McFarland et al. The test is considered positive when the appearance of sulcus in the subacromial space is more than 1cm as the humeral head translates in the inferior direction.To enhance the diagnostic accuracy, the test should be performed twice, first with the arm in neutral rotation and second with the arm in external rotation. Inferior translation should be the same in both positions. An increased degree of inferior translation with the arm in external rotation suggests a potential lesion of the rotator interval.
In Plain English
What Does a Positive Result Mean?
The visible presence of a **dimple or 'sulcus'** (a groove) beneath the acromion. The size of the sulcus is graded (Grade I <1cm, Grade II 1-2cm, Grade III >2cm).
Helpful Tip:
Indicates excessive inferior laxity. A positive test is often associated with MDI.
Safety First
This guide is to help you understand what happens in a clinic. Do not try to diagnose yourself. If you have severe pain, swelling, or cannot put weight on your leg, please visit an urgent care center or your doctor immediately.
Other Shoulder Tests
Apprehension Test (Anterior)
The Apprehension test is generally used to test the integrity of the glenohumeral joint capsule, or to assess glenohumeral instability in an anterior direction.
Hawkins-Kennedy Test
To detect **subacromial impingement syndrome**, specifically involving the supraspinatus tendon or biceps long head tendon.
Jobe's Test (Empty Can Test)
To assess for a tear or pathology of the **Supraspinatus muscle or tendon**.
Yergason's Test
To assess for **pathology of the Long Head of the Biceps tendon** (e.g., instability, tear, or tendinopathy) and its stability in the bicipital groove.