Sulcus Sign for Shoulder Instability

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Sulcus Sign

Purpose

The Sulcus sign is a clinical sign suggestive of:

Inferior glenohumeral instability / subluxation

It indicates laxity of the shoulder.

Technique

1. Patient should be relaxed.
2. Arm is kept by the side.
3. Examiner grasps the distal humerus.
4. Apply gentle downward traction to the arm.
5. Observe the region below the acromion.

Positive Sulcus Sign

A positive test produces:

A visible groove/depression below the acromion as the humeral head translates inferiorly.

This visible groove is the sulcus.

Interpretation

Positive Sulcus sign – inferior glenohumeral laxity/instability

Exam Pearl

Arm relaxed by side – downward traction – visible subacromial groove = positive Sulcus sign – inferior shoulder instability/laxity.