Clunk Test

What is the Clunk Test?

The is one of many physical examination techniques used by certain healthcare professionals when dealing with patients complaining about shoulder pain. This technique was created to assess the shoulder joints to see if a person has a potential labral tear, specifically superior anterior and posterior glenoid labral tears.

If a person has a shoulder labral tear, they are likely to have trouble sleeping due to the discomfort due to a throbbing pain in their shoulder joints. They will also likely feel a grinding or locking feeling in their shoulders when they move them. Since the labrum provides stability and cushioning to the shoulder joint, having a labral tear will result in the shoulder joint’s instability. Some labral tears can heal on their own by simply resting and avoiding strenuous activities that involve moving the shoulder a lot. Some labral tears need surgeries to fix them.

When performing the Shoulder Clunk Test, the healthcare professional will abduct the patient’s arm while externally rotating it. Doing so should produce an audible clunk, grinding, snapping, or clicking sound. If the shoulder makes any of those sounds, that’s a sign that the patient has a potential labral tear.

How to perform the Clunk Test

Now that you know what the Clunk Test is, it’s time to go beyond the description of the professional abducting the patient’s shoulder.

Before you conduct the Clunk Test on anyone, you will need a comfortable examination bed for your patient. This is the only thing you need besides your two hands for this test. Once the bed is prepared, have your patient lie down on it in a supine position (they must be facing up), and their specific placement on the bed should be close to the edge so that their affected shoulder is slightly over the edge of the bed.

Once the patient is in the proper position, you, the professional, will stand beside the patient on the side with the affected shoulder. Once you are in position, you will use one of your hands to hold the posterior aspect of the glenohumeral joint, while your other hand will hold the bicondylar aspect of the humerus above the elbow.

Next, you will fully abduct the patient’s arm over their head. While abducting the patient’s arm, you will also be doing two things at the same time, which are to apply an anterior force to the humerus as well as externally rotate the arm.

While performing the Clunk Test, you must be alert for certain feelings like clicking, locking, grinding, or snapping.

How to interpret the findings of the Clunk Test

Our previous directive was “be alert for certain feelings like clicking, locking, grinding, or snapping.” If you feel any of these while performing the Clunk Test, especially if they make an audible noise (and if the patient groans in pain or discomfort), that means they have a high chance of having a labral tear in their shoulder joint. This also means that they test positive for this test.

If the patient doesn’t feel anything and there are no clicking, locking, grinding, or snapping feelings and sounds, they are negative.

Now, what do you do when the patient is positive? The next best step is to endorse them for a comprehensive examination involving other tests like the Anterior Slide Test, O’brien’s Test, Speed’s Test, and imaging tests like MRI.

While a patient can test positive or negative for the Clunk Test, it should not be used as the sole assessment to confirm a diagnosis because it’s possible to get false positives or negatives from this test. That’s not to say that the Clunk Test is unreliable. It is, but it’s best to conduct other tests to confirm whether the suspicions that arise based on the Clunk Test results are true. Other tests will also have the chance to detect other potential issues besides labral tears in the shoulder joint.

Once a diagnosis is confirmed based on the collective results, you can determine if the patient needs to rest for the labral tears to heal or if they need surgery to fix the tears.

When is it best to conduct the Clunk Test?

If a person sets up an appointment with you, and during that appointment, they mention that they have pain in their shoulders, then that is one of the best times to conduct the Clunk Test. All the more if their medical history shows they have had shoulder and upper extremities problems!

If they’ve never had any problems with their shoulders before until now, then conducting this test can lead to early interventions and treatment before the shoulder problem, labral tear or not, worsens.

To reiterate an important point, the Clunk Test should not be the only test to identify and confirm shoulder labral tears. If a patient is undergoing a comprehensive physical examination of their upper extremities, especially their shoulders, that is the best time to conduct the Clunk Test. The reason is that the results of other tests can either confirm or refute the positive or negative result of the Clunk Test. Other tests can even detect other potential problems, and an MRI can confirm if there are labral tears in the shoulders.

The Clunk Test results can also serve as reminders for other professionals on the team conducting the comprehensive examination. The results can also serve as directives to further assess a shoulder using other techniques because there might be more than just labral tears.

Who can conduct the Clunk Test, and for whom is it?

The Clunk Test is primarily for patients with shoulder pains or patients with a history of shoulder pains and issues. More often than not, these patients are either elderly people who are deteriorating because of age or have suffered a fall, or athletes who partake in sports that involve a lot of shoulder movement, like basketball, weightlifting, and throwing.

As for those who get to conduct it, since the Clunk Test is a physical examination technique, the healthcare professionals who usually include this as part of their tests are orthopedists, physical therapists, occupational therapists, chiropractors, athlete physicians and trainers, and even rehabilitation specialists. These are healthcare professionals trained in assessing musculoskeletal problems, performing physical examination techniques, interpreting the results of such techniques, and treating patients based on comprehensive examinations.

Such professionals should be the only ones who conduct the Clunk Test on patients. Since it is a physical examination technique that involves moving the part in pain, patients will feel pain and discomfort. Highly trained and experienced professionals will know how to properly conduct the technique while ensuring they do not put the patient in unnecessary pain and that they do not aggravate any pre-existing conditions or the possible injury they’re seeking to identify.

What are the benefits of the Clunk Test?

It’s an inexpensive test to conduct.

The Clunk Test is non-invasive and is essentially a physical examination technique, so it doesn’t require anything from the healthcare professional except for a comfortable examination bed and their own two hands. It can also be accomplished relatively quickly since this test's instructions are easy to follow, so it will only take two to ten minutes.

It can lead to the early discovery of shoulder labral tears.

If a person sets up an appointment to discuss pains in their upper extremities, then the Clunk Test might be one of the tests you’d like to conduct to check for potential problems like labral tears. Suppose the labral tears are confirmed by the Clunk Test and other tests, including MRI. In that case, healthcare professionals have the opportunity to mitigate the damages and develop plans for early intervention and treatment. The earlier it is identified and confirmed, the earlier it can be managed and treated.

It can be used to monitor patients down the line.

Let’s say your patient has labral tears, as suspected by the Clunk Test and as confirmed by other tests, including an MRI. Let’s also stipulate that your team has already developed what goes into the treatment plan based on the results of the comprehensive examination you conducted and that you’ve implemented said plan.

Naturally, you’d want to know how the patient is doing. Are they getting better? Is the treatment plan working?

Using the Clunk Test doesn’t have to be a one-time, big-time thing during the early stages of examining the patient. It can be used down the line as a monitoring test. If the test results end up being negative, then great! The treatment went well, and your patient is recovering. If not, perhaps the plan isn’t working, so you must make adjustments. Or, the patient is just deteriorating, and the challenge is to help them live with the reality that their shoulder is messed up for good. Of course, we hope that doesn’t happen and that your plan is successful.