In preparing to do a surgical procedure, surgeons customarily reexamine patients in this position after they are anesthetized. After years of using the technique, many surgeons adopted it for their examination protocol in the office. How to Proceed At our clinic, standard tests are usually performed with the patient supine before the lateral decubitus position is used. The tests should be done on both shoulders for comparison purposes. After these maneuvers in the supine position, the patient rolls onto his or her unaffected side, with hips and knees flexed, and rests his or her back against the examiner.
Axial loading is provided by the weight of the arm plus gentle downward pressure.
If the patient begins to resist the examination, it is easy to help him or her relax by gently rotating the arm. As in the supine position, the affected and unaffected shoulders should be tested and the results compared. Testing should include placing the arm in the positions that typically provoke subluxation or dislocation if instability is present. The humeral head can then be felt to ride up to the glenoid rim or over the rim in cases of significant instability. Discreet popping and occasional catching may reveal that the patient has subtle labral tears as well.