Feagin test: How to perform, interpret, and document it

Key Takeaways

The feagin test assesses inferior glenohumeral joint instability with the arm at 90 degrees of abduction, targeting the inferior glenohumeral ligament (IGHL) and inferior capsule.

A positive sign is inferior translation of the humeral head or a palpable step-off, often accompanied by patient apprehension or pain.

Always compare bilaterally: bilateral laxity can mask pathology and lead to a false-negative result.

Pabau’s digital clinical notes and assessment tools help physiotherapy and sports medicine practices document Feagin test findings accurately within structured SOAP records.

Most shoulder instability examinations focus on anterior laxity. The inferior direction gets far less clinical attention. Yet inferior glenohumeral instability is a common finding in overhead athletes, swimmers, and gymnasts, and missing it can delay appropriate rehabilitation by months. Physical therapy EMR software designed for musculoskeletal practices can support structured documentation of these findings, but the clinical reasoning has to come first. This guide covers exactly that: how to perform the feagin test, how to interpret results, and where it fits within a full shoulder instability examination.

Feagin test: What it is and why it matters

The feagin test goes by three names in clinical literature: the Inferior Drawer Test, the Abduction Inferior Stability Test, and the John Feagin Test. All three describe the same procedure. The test evaluates inferior stability of the glenohumeral joint. The examiner applies a controlled downward force to the proximal humerus with the arm held at 90 degrees of abduction. A positive result indicates laxity of the inferior glenohumeral ligament (IGHL) and the inferior joint capsule.

Clinicians working in sports medicine practice encounter this presentation regularly. Overhead athletes, swimmers, gymnasts, and patients with generalized ligamentous laxity are the highest-risk populations. The feagin test is not a standalone diagnostic tool. It is one component of a systematic glenohumeral examination, used alongside tests like the sulcus sign and the load and shift test.

Anatomy: Why inferior stability matters

The inferior glenohumeral ligament is the primary static stabilizer of the glenohumeral joint at 90 degrees of abduction. It forms a hammock-like sling beneath the humeral head. Anterior and posterior bands within that sling resist anterior and inferior translation, depending on arm position. When the arm is elevated to 90 degrees, the IGHL becomes the dominant restraint against inferior displacement.

Three clinical populations account for most presentations of inferior instability:

• Overhead athletes (throwing sports, volleyball, swimming): Repetitive loading at 90 degrees abduction stretches the IGHL over time, creating gradual capsular laxity.
• Gymnasts and dancers: Generalized hypermobility combined with high shoulder loading accelerates capsular stretching.
• Post-dislocation patients: A prior anterior dislocation can damage the IGHL’s anterior band, leaving residual inferior instability even after anterior stability is restored.

Understanding the anatomy matters because it determines both the test’s biomechanical logic and its limitations. The feagin test isolates the IGHL specifically at 90 degrees of abduction. This is its key differentiator from the sulcus sign, which tests inferior capsular integrity with the arm at 0 degrees, at the side. Different structures are under load at that position.

How to perform the feagin test: Step-by-step

Consistent technique matters. Small variations in arm position or force direction can produce false negatives or unintended pain. Follow this protocol precisely.

Patient position

The patient stands upright. The arm on the side being tested is placed across the examiner’s shoulder at 90 degrees of abduction. The elbow stays extended, with the forearm resting comfortably. The patient should not be gripping anything or actively contracting shoulder musculature. Ask the patient to relax the shoulder completely before applying any force.

Examiner position and hand placement

Stand beside and slightly in front of the patient on the test side. Place both hands over the proximal humerus, interlacing your fingers so your palms contact the superior aspect of the humeral head. Your shoulder acts as the fulcrum that maintains the 90-degree arm position while your hands apply force.

Procedure and force application

Apply a smooth, controlled, inferiorly directed force through your interlaced hands onto the proximal humerus. The force should be gradual rather than sudden. Avoid jerking movements, which can cause pain without providing useful clinical information. Maintain the arm at 90 degrees throughout. Hold the position briefly. Observe for humeral head translation, a visible or palpable step-off below the acromion, or a pain and apprehension response from the patient.

Repeat on the contralateral side to establish a bilateral baseline. This is not optional. Bilateral comparison is essential for accurate interpretation.

Interpreting results: What is a positive feagin test?

A positive feagin test has two components, and both matter clinically.

• Mechanical sign: Visible or palpable inferior translation of the humeral head, sometimes described as a step-off or sulcus beneath the acromion during the applied force.
• Symptom response: Patient reports pain, apprehension, or a sensation of the shoulder “giving way” during the test.

A positive result indicates laxity of the IGHL and inferior joint capsule. It does not confirm a diagnosis of inferior glenohumeral instability on its own. Clinical correlation is required: symptom history, mechanism of injury, strength testing, and imaging findings all contribute to the full picture.

Critical caveat: bilateral laxity can produce a positive-appearing mechanical sign on both sides without representing pathology. A swimmer with constitutional hypermobility may show bilateral inferior translation that is entirely asymptomatic. Always compare the degree of translation and, critically, the symptom response between sides. Pathological instability is symptomatic. Physiological laxity typically is not.

Diagnostic accuracy: Sensitivity, specificity, and limitations

Published diagnostic accuracy data for the feagin test is limited. Unlike the sulcus sign or the apprehension test, the feagin test has not been the subject of large-scale validation studies. The available evidence base is small, and study quality is generally low. Textbook and secondary sources, including Magee’s Orthopedic Physical Assessment, commonly cite approximate values of 0.30 for sensitivity and 0.90 for specificity. Those figures come from compiled secondary sources, not a dedicated large-scale primary validation study. This does not mean the test lacks clinical value. It means clinicians should interpret results within a broader assessment framework, rather than treating a positive feagin test as a standalone confirmatory finding.

Combining instability tests, rather than relying on any single test in isolation, is standard clinical practice. A cluster approach pairs the feagin test with the sulcus sign, apprehension test, and load and shift test. Together they produce more reliable conclusions than any one test alone.

Clinical significance: When to use the feagin test

The feagin test belongs in a shoulder examination when inferior instability is part of the clinical picture. Four scenarios make it particularly relevant:

1. Overhead athletes with non-specific shoulder pain: Pain at 90 degrees abduction or during follow-through in throwing sports is a red flag for IGHL involvement.
2. Post-dislocation assessment: After an anterior glenohumeral dislocation, inferior instability can persist even when anterior stability has been restored.
3. Multidirectional instability (MDI) screening: In suspected MDI, assess inferior stability at both 90 degrees (feagin test) and 0 degrees (sulcus sign). Together they characterize the full instability pattern.
4. Generalized hypermobility with shoulder symptoms: Constitutional laxity does not always cause symptoms. When it does, mapping the direction and degree of instability informs rehabilitation priorities.

If you are running a physiotherapy clinic that handles musculoskeletal caseloads, a structured shoulder instability battery saves clinical time. It also reduces the risk of missed diagnoses. The feagin test takes under 60 seconds to perform. Its value is in the information it adds to the diagnostic picture, not in replacing clinical reasoning.

How the feagin test compares to related shoulder instability tests

No single test tells the full glenohumeral stability story. Here is how the feagin test sits within the broader shoulder instability examination battery, and what each test adds that the others do not.

Sulcus sign vs feagin test: Key differences

The sulcus sign and feagin test both evaluate inferior instability, but they test different structures at different arm positions. The sulcus sign, performed with the arm at the side, primarily stresses the superior capsule and rotator interval. The feagin test at 90 degrees of abduction shifts the load to the IGHL specifically. A patient can test positive for one and negative for the other. In multidirectional instability, both tests are typically positive, which is diagnostically significant. For physical therapy return-to-sport protocols, documenting findings from both tests gives a more complete picture of instability pattern and helps set realistic rehabilitation milestones.

Combining the sulcus sign and feagin test provides stronger clinical evidence for inferior instability than either test performed alone. Clinical reasoning, not test results in isolation, drives the diagnosis.

Documenting the feagin test in clinical practice

Documentation is where careful testing pays off or gets lost. A physiotherapy practice that performs the feagin test but records only “shoulder assessed” has captured none of the clinical reasoning behind it.

Effective documentation of the feagin test in SOAP notes should capture four elements:

1. Bilaterality: Record findings for both shoulders, not just the symptomatic side. Format: “Feagin test: Right (+) inferior translation approx. 1 cm, patient reports apprehension. Left (-) mild translation, asymptomatic.”
2. Degree of translation: Estimate or measure the visible/palpable step-off. Grading by degree (none, mild, moderate, severe) or in centimeters provides a baseline for monitoring change over time.
3. Patient response: Record whether the patient experienced pain, apprehension, a sense of instability, or no symptoms. The symptom response distinguishes pathological instability from physiological laxity.
4. Clinical reasoning: Note how the feagin test result feeds into the working hypothesis. If combined with a positive sulcus sign and a positive apprehension test, the cumulative picture supports multidirectional instability and informs the onward management plan.

Guidance on writing safer clinical notes and structuring SOAP notes effectively applies directly to musculoskeletal assessment documentation. The same principles, specificity, bilateral comparison, and linking findings to clinical reasoning, produce records that support both clinical care and medico-legal requirements.

For practices managing physiotherapy clinic compliance requirements, consistent test documentation also satisfies audit and professional registration obligations. The HCPC in the UK and the APTA in the US both require systematic assessment records. Findings must be clearly documented, not simply noted as complete. A feagin test result recorded only as “shoulder assessed” does not meet that standard.

Pabau’s patient record management tools and digital assessment forms help physiotherapy and sports medicine practices build structured musculoskeletal assessment templates. These templates capture bilateral findings, graded translations, and linked clinical reasoning in a single workflow. This eliminates the transcription errors that come from paper-to-screen transfer and keeps assessment records audit-ready.

If you are building or scaling a physiotherapy practice, the documentation workflow matters as much as the clinical protocol. Physiotherapy practice management software that integrates clinical notes with scheduling and compliance reporting reduces administrative overhead and supports consistent standard of care across clinicians.

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Pabau gives physiotherapy and sports medicine practices structured clinical note templates, bilateral assessment fields, and audit-ready patient records. See how it works in a short demo.

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Conclusion

Inferior glenohumeral instability is consistently under-assessed. The feagin test gives clinicians a fast, low-equipment method to evaluate IGHL integrity at the arm position most relevant to overhead function. Perform it bilaterally, interpret the mechanical and symptomatic findings together, and document both with enough specificity to track change over time.

Pabau’s structured assessment forms let physiotherapy and sports medicine practices capture bilateral instability findings, graded translations, and clinical reasoning in one place. Records stay consistent and compliance-ready. Book a demo to see how Pabau supports shoulder instability documentation in your practice.

Continue your research

Need a compliance framework for your physiotherapy practice? Physiotherapy clinic compliance requirements covers the documentation, registration, and audit obligations that apply to UK and US physiotherapy practices.

Building a return-to-sport program after shoulder injury? Physical therapy return-to-sport protocols outlines the staging criteria and progression milestones clinicians use before clearing athletes for full competition.

Want to improve your clinical note quality? Writing safer clinical notes provides a practical framework for documentation that reduces clinical risk and satisfies professional registration requirements.

Frequently Asked Questions