This prospective study introduces the crank test, a single physical exam maneuver for predicting glenoid labral tears before surgery. All 62 patients had refractory shoulder pain and underwent arthroscopy to confirm the diagnosis. The goal was a clinical test accurate enough to reduce reliance on MRI, especially in stable shoulders.
The decision rule here is simple: in a young patient with activity-related shoulder pain that failed 3 months of conservative care, a positive crank test points strongly to a labral tear. Set it up correctly. Elevate the arm to 160° in the scapular plane, apply axial load down the humerus, then rotate. Pain during external rotation, with or without a click, is a positive test.
The 160° position matters mechanically. The greater tuberosity clears the acromion, so subacromial impingement will not muddy the result. That is what separates labral pain from impingement pain on exam.
Watch the two failure modes. A partial articular-side cuff tear can give a false positive through posterosuperior impingement, and a labral tear can be incidental when a symptomatic cuff tear is the real culprit.
The broader lesson for boards is that a well-defined physical exam maneuver can rival or beat MRI for labral tears, particularly in stable shoulders where clinical criteria were previously weak.
This prospective study introduces the crank test, a single physical exam maneuver for predicting glenoid labral tears before surgery. All 62 patients had refractory shoulder pain and underwent arthroscopy to confirm the diagnosis. The goal was a clinical test accurate enough to reduce reliance on MRI, especially in stable shoulders.
The decision rule here is simple: in a young patient with activity-related shoulder pain that failed 3 months of conservative care, a positive crank test points strongly to a labral tear. Set it up correctly. Elevate the arm to 160° in the scapular plane, apply axial load down the humerus, then rotate. Pain during external rotation, with or without a click, is a positive test.
The 160° position matters mechanically. The greater tuberosity clears the acromion, so subacromial impingement will not muddy the result. That is what separates labral pain from impingement pain on exam.
Watch the two failure modes. A partial articular-side cuff tear can give a false positive through posterosuperior impingement, and a labral tear can be incidental when a symptomatic cuff tear is the real culprit.
The broader lesson for boards is that a well-defined physical exam maneuver can rival or beat MRI for labral tears, particularly in stable shoulders where clinical criteria were previously weak.