Designed to detect and grade laxity or insufficiency of the anterior capsular mechanism. (Analogous to the anterior drawer test of the knee). This test was proposed as useful in patients with a painful shoulder where the apprehension test is difficult to interpret. the many difference between this and therefore the load and shift is that the absence of a force ‘loading’ the humeral head into the center of the glenoid at the beginning of the test.
Test
Ideally, this test should be performed with the patient in supine as sitting and standing positions are shown to be unreliable with reference to reproducibility.
The examiner stands facing the affected shoulder e.g. left. They fix the patient’s left in their right axilla by adducting their humerus.
The affected shoulder is held at 80-120° of abduction, 0-20° of forwarding Flexion, and 0-30° of external rotation. The examiner holds the patient’s scapula spine forward together with his index and middle fingers; the thumb exerts counter pressure on the coracoid. The scapula is fixed. The examiner uses his right to understand the patient’s relaxed upper arm and draws it anteriorly with a force like that utilized in a Lachmann’s test. (NB it’s possible to repeat the anterior drawer in several positions of abduction and external rotation as described within the load and shift test to check the individual components of the GHL complex.)
Positive
The relative movement between the fixed scapula and therefore the moveable humerus can easily be appreciated and graded. Occasionally the examiner may reproduce an audible click on forward movement of the humeral head thanks to labral pathology and this is often usually related to apprehension.
References
Anterior Apprehension Test
