The clinician is beside the patient with the inside of the hand over the patient’s shoulder and forearm, stabilizing the scapula to the thorax.
The clinician places his or her hand across the gleno-humeral G-H joint line and humeral head, so that clinician’s little finger is positioned across the anterior G-H joint line and humeral head.
The clinician then applies a “load and shift” of the humeral head across the stabilized scapula in an anteromedial direction to assess anterior stability, and in a posterolateral direction, to assess posterior instability.
The test should be compared to the contralateral side.
This test can also be performed in sitting position:
The arm by the side of the body, patient relaxed with forearm over the lap, examiner standing from back, with one hand hold the scapula with fingers in the front of shoulder over coracoid and thumb in the back over the angle of acromion, with the other hand hold the head of humerus.
Perform the anterior translation test.
Comparison must be made to the asymptomatic contralateral side.
The amount of anterior translation is graded:
Grade 0- Little / no movement.
Grade 1- humeral head rides up the glenoid slope but not over the rim.
Grade 2-humeral head rides up and over the glenoid rim but reduces spontaneously when stress is removed.
Grade 3-humeral head rides up and over the glenoid rim and remains dislocated on removal of stress.
What does a positive Load and Shift Test mean?
Load and Shift test is Positive when there is increased translation of the humeral head compared to the contralateral side.
The load and shift test can be used to classify degrees of instability based on distance of humeral head translation:
1+: 0 to 1 cm of translation to before glenoid rim.
2+: 1 to 2 cm of translation to glenoid rim.
3+: more than 2 cm translation or over glenoid rim.
The normal motion anteriorly is half of the distance of the humeral head.
Sensitivity & Specificity
Sensitivity: 50-55 %
Specificity: 78-100 %
By progressive external rotation and abduction there is less translation anteriorly, as inferior glenohumeral ligament becomes taut.
Similarly by internal rotation of the arm posterior translation is diminished with intact posterior capsular structure.
Vincent A. Lizzio, Fabien Meta, Mohsin Fidai, and Eric C. Makhnicorresponding author. Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017 Dec; 10(4): 434–441. PMID: 29043566.
Gerber C, Ganz R: Clinical assessment of instability of the shoulder. J Bone Joint Surg 66B:551, 1984.
Clinical Tests for the Musculoskeletal System 3rd Edition.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.