Sulcus Test: Shoulder Instability Assessment

The sulcus test is an orthopedic special test that checks for inferior glenohumeral instability. The examiner pulls the arm downward and measures the gap that opens below the acromion. A gap wider than on the other shoulder, graded I to III by size, points to inferior laxity.

This article covers how to perform the test, grade the sulcus sign and record the result on a structured form. Physical therapists, chiropractors and sports medicine clinicians use the test as part of a wider shoulder examination. Its value depends on consistent technique and clear documentation, which is where a standard form helps.

Key takeaways

The sulcus test is a clinical assessment for inferior glenohumeral instability, not a standalone diagnosis.

The free template records patient information, history and pre-test questions, then sets out the procedure with traction applied at the elbow.

Always compare with the contralateral shoulder, since generalized laxity can produce a positive finding.

Practice software such as Pabau lets you store sulcus findings in custom digital forms within the patient record.

What the assessment form covers

A sulcus test assessment form is a structured record of the test. It covers the patient’s details, their history, a set of pre-test questions and the procedure itself. It gives the clinician one place to capture findings that are otherwise scattered across handwritten notes.

The sulcus test itself assesses inferior glenohumeral stability. Clinical documentation of the result matters because it supports the treatment plan and shows change over time. In the UK, for example, the Health and Care Professions Council (HCPC) expects physiotherapists to keep clear, accurate records of the assessments they perform.

How to fill out the template

The template follows the order of a typical assessment, from patient details to the test itself. Follow these five steps.

1. Fill in the patient information. Enter the patient’s details in the fields at the top of the form.
2. Record the history. Use the chief complaint and history of present illness boxes to capture why the patient came in and how the symptoms developed.
3. Ask the pre-test questions. Work through the five patient questions and note each answer in its box before you start the test.
4. Perform the test. Follow the step-by-step procedure, applying downward traction at the elbow while your other hand steadies the shoulder.
5. Check the interpretation note. Read the short note on what the result means, then record the sulcus size and the comparison with the other shoulder in your clinical notes.

What the sulcus test measures

The sulcus test is used to assess inferior glenohumeral instability. A positive sulcus sign is a gap between the acromion and the humeral head when inferior traction is applied.

The coracohumeral ligament and rotator interval are the main restraints to inferior translation of the humeral head. When these structures are lax, the humeral head moves inferiorly under traction, and the resulting sulcus gap is what clinicians grade.

Who uses the form

Physical therapy practices use the form when assessing patients with shoulder pain, recurrent dislocation or suspected multidirectional instability. Clinicians working in sports medicine use it to screen athletes before and after return-to-play decisions.

Chiropractors and musculoskeletal practitioners also use the test during upper quadrant examinations, where a consistent record makes it easier to compare findings across visits.

Why a standard form helps

A standard form keeps the history, pre-test questions and procedure in the same order for every patient, so steps are less likely to be skipped. Note the comparison with the uninjured shoulder alongside it, because a missing comparison is a common reason a sulcus finding is hard to interpret later.

Consistent records also make it easier to show change over time, which supports both treatment decisions and discussions with referrers.

Sulcus test procedure and grading

The patient sits with the arm relaxed at the side and the examiner applies a steady inferior traction force at the wrist or elbow. The examiner watches the gap below the acromion and measures it against the humeral head.

Grading is based on the distance of the sulcus. The table below sets out the commonly cited bands, which are attributed to the Altchek classification in most sources. The template has no grading field, so record the grade in your clinical notes.

Interpreting a positive sulcus sign

A positive sulcus sign is a finding that needs context. Generalized ligamentous laxity can produce a sulcus in a shoulder that is lax but stable, so the uninjured side is essential for comparison. A Beighton score shows whether the laxity extends to other joints.

The sulcus test has limited accuracy on its own. Clinicians usually combine it with other tests in the shoulder examination before reaching a conclusion. The Gagey test is a common partner, because it stresses the inferior glenohumeral ligament from a different position. The chart below shows how each grade translates into a next step.

Related shoulder instability tests

The sulcus test sits alongside the apprehension test and the load and shift test. Each adds a different piece of evidence about the stability of the glenohumeral joint.

Recording all of these results on one form keeps the examination consistent. Our guide to shoulder special tests shows how each one fits into a full assessment.

Recording shoulder instability findings in Pabau

On paper, the sulcus grade and the side-to-side comparison often end up in free-text notes, where they are hard to find at the next visit.

Pabau, the physical therapy EMR we build, turns this template into a custom assessment form through its digital forms. You can add your own fields, such as the sulcus grade and a side-by-side shoulder comparison. The completed form is stored against the patient for the next visit.

The patient record keeps sulcus findings alongside treatment notes and follow-up appointments. Outcomes are easier to track across a practice with several clinicians, because each one sees whether laxity has changed since the last visit.

Keep shoulder instability findings in one record

Pabau’s digital forms turn the sulcus test template into a custom assessment form with your own grading fields. Each completed form is saved to the patient record, so findings are ready to compare at the next visit.

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Conclusion

The sulcus test is quick to perform, but a single positive sign proves little on its own. Its value comes from consistent technique, a comparison with the other shoulder and the other instability tests that sit beside it.

Use the template to keep the history, pre-test questions and procedure the same for every patient. Then record the grade and the side-to-side comparison in your notes, so the next clinician can see whether laxity has changed.

Treat a Grade II or III finding as a reason to test further, not as a diagnosis. Book a demo to see how Pabau keeps shoulder assessment findings in one patient record.

Continue your research

Want a second test for anterior and posterior laxity? Free load and shift test template covers how to grade humeral head translation against the glenoid.

Building a full shoulder examination? Shoulder special tests: technique, sensitivity, and interpretation shows how each test fits into a wider assessment.

Need a range-of-motion baseline as well? Shoulder range of motion chart template gives you a printable chart for active and passive movement.

Checking for anterior instability too? Shoulder relocation test: technique, interpretation and accuracy explains how the test confirms an apprehension finding.

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