Jobe Relocation Test
The Jobe Relocation test (JRT) was originally devised to distinguish patients with anterior instability (and possible secondary Rotator Cuff Impingement symptoms) from those with Primary Impingement. It has previously been advocated as the most sensitive clinical test to determine the presence of occult or subtle anterior instability especially in the face of secondary impingement. However until Speer's study (1994) no objective evaluation of this test had been undertaken.
The examiner repeats the apprehension test and notes the amount of external rotation before the onset of apprehension. They then return to the start position and apply a posterior stress over the humeral head. They then repeat the external rotation manoeuvre and again note amount of external rotation at onset of apprehension.
An increase in the external rotation range before symptom/apprehension reproduction with application of the posterior glide on the humeral head=positive. It is important to note that according to Speer's paper (1994) pain alone is not nearly as reliable regarding instability as apprehension.
Jobe proposed that the anteriorly directed force tends to compress the rotator cuff tendon between the greater tuberosity and the posterior superior region of the glenoid rim; thus patients with minor instability will experience pain but not apprehension. When applying a posteriorly directed force this impingement will be relieved and pain will disappear. Patients that experience pain during the apprehension test should be suspected of having subtle instability and secondary impingement (according to Jobe's original description).
Speer's study looked at 100 patients undergoing shoulder surgery. Diagnosis was based on operative fmdings and examination under anaesthetic. As well as the standard relocation test he also included the Anterior Relocation test (ART) when an anterior directed force was applied during external rotation.
It should be noted that for the purposes of the study abduction and external rotation testing were standardised to 90°/90°. Further more as Sorensen reports Speer et al excluded patients presenting with coexisting anterior instability and rotator cuff lesions - therefore the study is less conclusive regarding the evaluation ofthe relocation test