The shoulder joint is a highly mobile joint that relies on a combination of bony anatomy, ligaments, and muscular control to maintain stability. Shoulder instability can occur in multiple directions – anterior, posterior, superior, and inferior. Among these, inferior instability is the least common.

The Sulcus Sign (or Sulcus Test) is a clinical test used to assess for inferior instability of the shoulder joint. When a positive Sulcus Sign is present, it indicates that there may be inferior glenohumeral instability, often secondary to laxity or insufficiency of the superior glenohumeral ligament and/or the coracohumeral ligament.

Procedure:

The patient sits or stands with the arm relaxed by their side.
The examiner grasps the elbow and applies a downward force, attempting to distract the humeral head inferiorly.
Observation is made for a sulcus or depression to appear below the acromion.
Interpretation:

Positive Test: A noticeable depression (or sulcus) forms below the acromion process of the scapula, indicating inferior translation of the humeral head. The depth and permanence of the sulcus can be graded:

Grade 1: Sulcus up to 1cm
Grade 2: Sulcus between 1-2cm
Grade 3: Sulcus greater than 2cm
Negative Test: No sulcus or depression forms beneath the acromion.

It's worth noting that a positive Sulcus Sign is not definitive proof of pathology. Some people, especially those with generalized joint hypermobility, might display a positive Sulcus Sign without any clinical symptoms or history of instability. As with all clinical tests, the Sulcus Sign should be interpreted in the context of a comprehensive evaluation that considers the patient's history, physical examination findings, and additional diagnostic information.

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