The Thumb Test: A Simple Physical Examination Maneuver for the Diagnosis of Symptomatic Posterior Shoulder Instability

Management of Bone Loss in Posterior Glenohumeral Shoulder Instability

“…After a general shoulder examination, special testing such as the posterior load and shift, apprehension testing, Jerk test, and Kim test should be performed 1 . Recently, Boileau et al suggested the use of a new test for posterior instability coined the “thumb test,” in which the examiner places a thumb posterior and inferior to acromion while the patient elevates the arm, with positive test being relief of pain/instability when compared with no thumb applied 13 . Although this test has yet to be validated in relation to PSI, its use can be considered as an adjunct during evaluation to simulate a posterior bone block procedure.…”

Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management

“…The effect of supporting the posterior humeral head during active range of motion has been previously described by Watson in PSI 47 and MDI 94,95,101,102 and by Boiletee and colleagues (the Thumb assistance test) for PSI. 103 While correction of the anterior humeral head has good inter-rater reliability (sensitivity: 63.89%; specificity: 98.91%), 104 the psychometric properties of posterior humeral head correction have yet to be evaluated. 103 Irrespective of the corrective method used, the aim of shoulder assistive techniques should be to determine which position produces the largest reduction in symptoms for the patient.…”

“…103 While correction of the anterior humeral head has good inter-rater reliability (sensitivity: 63.89%; specificity: 98.91%), 104 the psychometric properties of posterior humeral head correction have yet to be evaluated. 103 Irrespective of the corrective method used, the aim of shoulder assistive techniques should be to determine which position produces the largest reduction in symptoms for the patient.…”

“…The effect of correction can be used to determine if aberrant scapular motion and posterior humeral head translation are contributing to the patient's symptoms as well as assist in differential diagnosis. 47,61,103 For example, apparent restrictions in horizontal adduction and/or IR range are common findings in PSI and patients may be misdiagnosed as having a tight posterior capsule and/or GIRD. 46 If therapist-assisted support of the humeral head to prevent posterior translation improves range of motion (Figure 4), then pathological capsular restriction is unlikely to be a contributing factor to the patient's presentation.…”

“…46 If therapist-assisted support of the humeral head to prevent posterior translation improves range of motion (Figure 4), then pathological capsular restriction is unlikely to be a contributing factor to the patient's presentation. 47,103 Similarly, the findings of tests for 'impingement' and SLAP tears may change. For example, although the O'Brien's test can be diagnostic of a SLAP tear, 105 if correction of the posterior humeral head improves symptoms, then posterior humeral head translation may be contributing to a positive O'Brien's test, and not necessarily a structural lesion.…”