Signs of Fowler (fear of repositioning test): why and mechanism of symptom development

2021-01-26 12:00 AM

If the rotator cuff test positive for the patient by pushing the head near the arm bone forward and reducing that fear by pushing it backwards in the same plane, the test is positive.

The Fowler sign is often used in conjunction with (used immediately after completion) of the crank arm test.

While the patient is sitting or lying on his back, move the arm passively to a pose and rotate outwards. In this test, however, the examiner's right hand is placed on the front of the head near the brachial bone to push the head of the arm bone back.

The test is positive if the patient has decreased symptoms caused by the previous arm crank test. In short, if the examiner causes the patient's positive rotational arm test by pushing the head near the arm bone forward and reducing that fear by pushing it backwards in the same plane, the test is positive.

Figure. Fear test - repositioning (Fowler's sign)

Note the force acting on the head near the arm bone from the front.

Reason

Loss of anterior joint equilibrium - see disturbances in positive spindle therapy.

Mechanism

The anatomy and cause of the anterior joint loss of the joint have been described in the "arm rotation test".

The main difference between the two treatments is the symptom relief of pushing the head near the arm bone back. This is thought to be due to one of the following reasons:

The brachial tip located at the apex of the anterior lesion was pushed back and thus returned to its normal anatomical position.

The back thrust acts as a "support structure" for the shoulder joint, giving the patient more confidence that dislocations will not occur and thus alleviates fear.

Meaning

The repositioning test is considered the gold standard with frontal shoulder instability by some authors. When the anxiety and painless reduction is considered a positive test, it has a very high specificity and positive predictive value (PPV).

Studies by Speer and CS; Lo and CS showed that this was a very specific test for the diagnosis of anterior shoulder instability with 68% sensitivity, 100% specificity and 100% PPV as well as 31.94% sensitivity, 100% and 100% PPV in studies.

However, using the criteria of pain or fear, Lo and CS found that the results were less specific with a sensitivity of 45.83%, specificity 54.36% and PPV 56.26%.

In short, if there is a decrease in fear in the frightening test - repositioning, anterior dislocation of the shoulder joint is almost certainly there. Its usefulness is further increased if used in conjunction with the fear-provoking method.