SULCUS SIGN

​• ​Test positioning

The client sits with the forearms and hands resting in their lap.

The therapist stands with the proximal hand grasping the client's scapula (superiorly) and the distal hand grasping the client's elbow.

​• ​Action

With the scapula stabilized the therapist applies an interior (distraction) force with the distal hand.

​• ​Positive finding

Excessive interior humeral head translation with a visible and/or palpable "step off" or "sulcus" deformity immediately inferior to the acromion (laterally) is indicative of inferior and/or multidirectional instability.

​• ​Special considerations & comments

A positive sulcus sign at rest may indicate excessive capsular stretching.

This may also be accompanied by a neurological stretch to structures of the brachial plexus.

The Sulcus Sign Test is attributed to the work of Dr. James Andrews and Dr. John C. Kennedy, whose contributions to understanding shoulder instability and joint mechanics have been significant in the development of this assessment.