From the Guidelines
The Watson test is not a recommended diagnostic procedure for shoulder pain or traumatic shoulder injuries, as the most appropriate initial study is radiography of the shoulder, followed by MRI or CT scans based on specific clinical findings. When evaluating shoulder pain, the choice of diagnostic test depends on the clinical presentation and history of the patient. For traumatic shoulder pain, radiography is the initial study of choice, as it can help identify fractures or dislocations 1.
In cases where radiographs are negative, but there is suspicion of labroligamentous injuries or shoulder instability, MRI of the shoulder without IV contrast or MR arthrography may be appropriate 1. MR arthrography is particularly useful for evaluating subacute shoulder dislocations, recurrent shoulder instability, and labroligamentous injuries, as it has been shown to be reliable in diagnosing these conditions 1.
Some key points to consider when evaluating shoulder pain include:
- Radiography is the most appropriate initial study for traumatic shoulder pain 1
- MRI or CT scans may be necessary based on specific clinical findings, such as fractures or dislocations 1
- MR arthrography is preferred for evaluating subacute shoulder dislocations or recurrent shoulder instability 1
- The choice of diagnostic test should be guided by the patient's clinical presentation and history.
It is essential to prioritize the most recent and highest quality studies when making diagnostic decisions, and to consider the potential risks and benefits of each diagnostic test in the context of the patient's individual needs 1.
From the Research
Watson Test
- The Watson test is not explicitly mentioned in the provided studies, but the Watson Instability Program (WIP1) is discussed in the context of atraumatic shoulder instability 2.
- The WIP1 is a conservative management program for atraumatic shoulder instability, and its effectiveness has been studied in the context of telehealth delivery 2.
- The study found that the WIP1 delivered via tele-consultation resulted in significant improvements in shoulder symptoms and function in circus performers with atraumatic shoulder instability 2.
Shoulder Instability
- Shoulder instability can be caused by traumatic injury, and the most common form of instability is anterior shoulder instability 3, 4, 5, 6.
- The diagnosis and management of traumatic anterior shoulder instability involve careful patient selection, primary shoulder stabilization, and consideration of concomitant injuries 4.
- Rehabilitation for shoulder instability aims to restore pain-free mobility, strength, and functioning, and implements range of motion and strengthening exercises to restore proprioceptive control and scapular kinematics 5, 6.
Diagnostic Tests
- The apprehension test, relocation test, and anterior drawer test are commonly used to diagnose traumatic anterior shoulder instability 3.
- The sensitivity, specificity, and likelihood ratio of these tests vary, but the apprehension test and relocation test are found to be specific but not sensitive for diagnosing traumatic anterior shoulder instability 3.
- The anterior drawer test can be helpful for diagnosing traumatic anterior instability, especially when reproduction of instability symptoms is used as the criterion for a positive test 3.