The Load and Shift Test is an orthopedic shoulder test to assess anterior and posterior shoulder instability. The load and shift test as described by Hawkins may be a modification of the anterior and posterior drawer tests of Gerber and Ganz. it’s been considered the gold standard for the assessment of anterior and posterior instability.
Test
The examiner creates a loading force to relocate the humeral head centrally within the glenoid. during this ‘loaded position’ directional stresses are applied. The examiner places one fork over the shoulder and scapula to stabilize the pectoral arch and uses the opposite hand to understand the humeral head. The humerus is loaded into the glenoid and then translated anteriorly and posteriorly. because the stress applied is increased the humeral head could also be felt to ride up the glenoid rim. This test not only assesses the quantity of translation but also provides thought on the adequacy of the glenoid lip. it’s critically important to match the 2 shoulders to understand similarities or differences in translation.
The test is then repeated supine. For this position, the arm is grasped
and positioned in about 20° of abduction and forward flexion. The humeral head is again loaded then posterior and anterior stresses are applied. Although translation is assessed initially within the neutral position with the arm by the side it’s important to assess translations in other positions also. for instance, by progressively externally rotating the arm within the normal jostle abduction one should appreciate less translation anteriorly because the inferior glenohumeral ligament (GHL) becomes taut and acts as a restraint. Similarly by internally rotating the arm posterior translation is diminished with an intact posterior capsular structure.
or
The patient should be seated. The therapist stabilizes the scapula to the thorax with one hand, while the opposite hand is placed across the posterior GH joint line and humeral head, and therefore the webspace across the patient’s acromion. The index should the over the anterior GH joint line. The clinician should now apply a “load and shift” of the humeral head across the stabilized scapula in an anteromedial direction to assess anterior stability, and during a posterolateral direction to assess posterior instability. Normal motion anteriorly is half the space of the humeral head, more movement is taken into account to be a symbol of GH joint laxity.
| Range of abduction | Structure tested |
| 0 – 60° | Superior GHL/Coracohumeralligt/rotator interval |
| 60 – 90° | Middle GHL |
| 90°+ | Inferior GHL |
Positive
Grading system utilized to quantify the amount of translation
| I | Mild | 0-lcm translation |
| II | Moderate | 1-2 cm or translates to the glenoid rim |
| III | Severe | >2cm translation or over the rim of the glenoid |
References
