Hyper Extension-Internal Rotation (HERI) Test for shoulder instability

The Hyper extension-internal rotation Test or  HERI Test is a special orthopaedic/orthopedic test for the shoulder that attempts to test specifically for anterior glenohumeral instability due to inferior glenohumeral ligament (IGHL) and glenohumeral capsule damage.  Existing tests put the patient in positions that cause apprehension and/or pain. This test was developed to avoid that.

Humeral flexion and extension.
Humeral flexion and extension.

Involved Structures

  • inferior glenohumeral ligament (IGHL)
  • glenohumeral articular capsule

Starting Position

You can perform this test with the patient in standing or in supine. Have the non-test arm in full (180 degrees) forward flexion. The affected arm, or arm to be tested, is in neutral flexion and full internal rotation.

Test Movement

While the non-test arm is held in full flexion, the examiner holds the arm on the side to be tested in internal rotation. The examiner then fully extends the patient’s arm at the glenohumeral joint. Note the degree of extension possible. The test is then repeated on the opposite side, again noting the degree of extension possible.

Positive Test

In a positive test, there is a significantly greater amount of glenohumeral extension possible on the affected side. The difference in the amount of extension is generally about 14 degrees.

Accuracy of Test

This is a relatively new test so accuracy has not been extensively tested. However, the initial studies look promising. See: Hyper extension-internal rotation (HERI): A new test for anterior gleno-humeral instability

Video Demonstration

No video demonstration available at this time

>> Return to the list of Orthopedic Tests of the Shoulder

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