Load and Shift Test

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 3 min read

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Article Summary

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...

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Educational health guideWritten for patient understanding and clinical awareness.

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Emergency safety firstUrgent warning signs are highlighted below.

Definition

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.

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

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

Write when the problem started and how it changed.
Bring old prescriptions, investigation reports, and current medicines.
Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

What is the most likely cause of my symptoms?
Which danger signs mean I should go to hospital quickly?
Which tests are necessary now, and which can wait?
How should I take medicines safely and what side effects should I watch for?
When should I come for follow-up?

Tests to discuss

Vital signs: temperature, pulse, blood pressure, oxygen saturation
Basic physical examination by a clinician
CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Rest, drink safe water, and observe symptoms carefully.
Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider

Tests to discuss with doctor

Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
Relevant blood, urine, imaging, or specialist tests only after clinical assessment

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

Internal learning pathway

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