Sulcus sign
Sulcus sign is an orthopedic evaluation test to assess the glenohumeral joint instability of the shoulder, due to laxity of the superior glenohumeral ligament and coracohumeral ligament 1. A sulcus is defined as a depression greater than a finger breadth between the lateral acromion and the head of the humerus 2. Sulcus test is considered positive when a sulcus sign is seen when the examiner applies a downward force applied at the elbow while the arm in neutral rotation and resting at the patient’s side.
Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This can happen as a result of a sudden injury or from overuse.
Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.
Shoulder anatomy
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head, or ball, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid. Strong connective tissue, called the shoulder capsule, is the ligament system of the shoulder and keeps the head of the upper arm bone centered in the glenoid socket. This tissue covers the shoulder joint and attaches the upper end of the arm bone to the shoulder blade.
Your shoulder also relies on strong tendons and muscles to keep your shoulder stable.
Figure 1. Shoulder anatomy
Sulcus sign test
Sulcus sign test can be administered with the patient either seated or standing with his arm relaxed at her side. The examiner palpates the shoulder by placing her thumb and fingers on the anterior and posterior aspects of the humeral head.
The examiner grasps the patient’s elbow with her other hand and applies a downward distraction force. With excessive inferior translation, a depression occurs just below the acromion. A positive test will result in a sulcus being formed between the acromion and the humeral head as the humeral head moves inferiorly while the force is being applied.
Positive sulcus sign treatment
Chronic shoulder instability is often first treated with nonsurgical options. If these options do not relieve the pain and instability, surgery may be needed.
Nonsurgical treatment
Your doctor will develop a treatment plan to relieve your symptoms. It often takes several months of nonsurgical treatment before you can tell how well it is working. Nonsurgical treatment typically includes:
- Activity modification. You must make some changes in your lifestyle and avoid activities that aggravate your symptoms.
- Non-steroidal anti-inflammatory medication. Drugs like aspirin and ibuprofen reduce pain and swelling.
- Physical therapy. Strengthening shoulder muscles and working on shoulder control can increase stability. Your therapist will design a home exercise program for your shoulder.
Surgical treatment
Surgery is often necessary to repair torn or stretched ligaments so that they are better able to hold the shoulder joint in place.
- Arthroscopy. Soft tissues in the shoulder can be repaired using tiny instruments and small incisions. This is a same-day or outpatient procedure. Arthroscopy is a minimally invasive surgery. Your surgeon will look inside the shoulder with a tiny camera and perform the surgery with special pencil-thin instruments.
- Open surgery. Some patients may need an open surgical procedure. This involves making a larger incision over the shoulder and performing the repair under direct visualization.
- Rehabilitation. After surgery, your shoulder may be immobilized temporarily with a sling.
When the sling is removed, exercises to rehabilitate the ligaments will be started. These will improve the range of motion in your shoulder and prevent scarring as the ligaments heal. Exercises to strengthen your shoulder will gradually be added to your rehabilitation plan.
Be sure to follow your doctor’s treatment plan. Although it is a slow process, your commitment to physical therapy is the most important factor in returning to all the activities you enjoy.
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