Norwood Stress Test

Original Editor - Kehinde Fatola
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Purpose[edit | edit source]

Norwood stress test is used in evaluating the posterior capsule of the shoulder to check for posterior instability of the shoulder joint. [1]

Technique[edit | edit source]

[2]

The patient lies in a supine position with the shoulder at 90° abduction, with some external rotation, so the arm is horizontal while the forearm is vertical. The elbow is at 90° flexion. [1]

The examiner stands at the affected side and places one hand on the shoulder with the thumb directed anteriorly while the other fingers are positioned around the back of the head of humerus, the other hand holds the forearm proximal to the wrist so as to control the movement of the arm. The fingers at the back of the humeral head is used to feel for any posterior translocation while the arm is adducted passively until the arm is vertical. A positive test is indicated by a familiar sensation of instability apprehension and pain by the patient, a posterior semiluxation may occur before sensation is felt as the head of humerus glides over the glenoid labrum. [1]

Clinical Context[edit | edit source]

It has been estimated that posterior instability constitutes only 2% of shoulder dislocation making it the least the common type of shoulder instability. [3] Traumatic posterior shoulder dislocation may be a sequela to recurrent posterior instability but it is less common than the anterior instability experienced due an anterior dislocation. [4] In the normal shoulder, the test position of flexion and adduction causes tightening of the posterior capsule and this restricts posterior humeral translation. If excessive movement is detected, significant capsular and/or labral injury should be suspected. [5] Additional tests such as the load and shift test and the posterior drawer test should be used to support the diagnosis of instability. [4]

Variations[edit | edit source]

The jerk test/posterior glide test/90° flexion test is similar and performed with the patient in a sitting position. With the elbow flexed to 90° and the arm internally rotated across the waist, the shoulder is taken into 90° of forward flexion. [1]

Related Tests[edit | edit source]

  • Posterior apprehension stress test
  • Push–pull test

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010.
  2. Norwood Stress Test. The Physio Channel. Available from; https://www.youtube.com/watch?v=-J2wG1SS_vk (accessed 22/March/2021)
  3. Cicak, N., 2004. Posterior dislocation of the shoulder. J. Bone Joint Surg. Br. 86 (3), 324–332.
  4. 4.0 4.1 Robinson, C.M., Aderinto, J., 2005. Recurrent posterior shoulder instability. J. Bone Joint Surg. Br. 87 (4), 883–892.
  5. Ellenbecker, T.S., 2004. Clinical Examination of the Shoulder. Elsevier, St Louis.