Jobe Relocation Test (also referred to as the Fowler Sign) is to test for anterior instability of the glenohumeral joint. The Jobe Relocation test (JRT) was originally devised to distinguish patients with anterior instability (and possible secondary Rotator Cuff Impingement symptoms) from those with Primary Impingement. It has previously been advocated as the most sensitive clinical test to determine the presence of occult or subtle anterior instability, especially in the face of secondary impingement. However, until Speer’s study (1994) no objective evaluation of this test had been undertaken.
This test is extremely similar in nature to the Apprehension Test and is usually administered after the Apprehension Test, to research a positive result. The patient is positioned supine, with the elbow flexed to 90 degrees and abducted to 90 degrees. The therapist then applies an external rotation force to the shoulder, if the patient reports apprehension in any way, the Apprehension Test is taken into account to be positive. At now, the therapist may apply a posteriorly directed force to the shoulder – if the patient’s apprehension or pain is reduced during this position, the Jobe Relocation Test is taken into account to be positive. it’s important to notice that the therapist should bring the arm back to a neutral position before releasing the relocation force (posterior glide of the top of the humerus) for the danger of shoulder dislocation.
If the patient’s symptoms decrease or are eliminated when performing the Jobe Relocation Test, the possible diagnoses include glenohumeral instability, subluxation, dislocation, or impingement.
If the apprehension predominated when performing the Crank Test and disappears with the Jobe Relocation Test, the diagnosis can include a pseudo laxity of anterior instability of the GH joint, or potentially the scapulothoracic joint. it’s important to also consider a secondary impingement or a posterior SLAP labral legion.
Test
The examiner repeats the apprehension test and notes the quantity of external rotation before the onset of apprehension. They then return to the beginning position and apply posterior stress over the humeral head. They then repeat the external rotation maneuver and again note the quantity of external rotation at the onset of apprehension.
Positive
An increase within the external rotation range before symptom/apprehension reproduction with the appliance of the posterior glide on the humeral head=positive. it’s important to notice that consistent with Speer’s paper (1994) pain alone isn’t nearly as reliable regarding instability as apprehension.
Jobe proposed that the anteriorly directed force tends to compress the structure tendon between the greater tuberosity and therefore the posterior superior region of the glenoid rim; thus patients with minor instability will experience pain but not apprehension. When applying a posteriorly directed force this impingement is going to be relieved and pain will disappear. Patients that have pain during the apprehension test should be suspected of getting subtle instability and secondary impingement (according to Jobe’s original description).
Research
Speer’s study checked out 100 patients undergoing shoulder surgery. The diagnosis was supported by operative findings and examination under anesthetic. also because of the standard relocation test he also included the Anterior Relocation test (ART) when an anteriorly directed force was applied during external rotation.
It should be noted that for the needs of the study abduction and external rotation testing were standardized to 90°/90°. Furthermore, as Sorensen reports Speer et al excluded patients presenting with coexisting anterior instability and structure lesions – therefore the study is a smaller amount conclusive regarding the evaluation ofthe relocation test
References
Sulcus Sign Tests
