Load and Shift Test | Shoulder Instability Assessment

 The Load and Shift Test is an orthopedic shoulder test to assess anterior and posterior shoulder instability. According to Morey et al. (2016) the load and shift test has a sensitivity of 37.5% and a specificity of 89.2% in the detection of shoulder instability. On top of that, Eshoi et al. (2018) evaluated the test regarding its reliability and found and inter-rater Kappa k of 0.48, which signifies moderate reliability.

To perform the test have your patient in sitting position with his arm resting on the thigh, a straight posture, and relaxed muscles.
Stabilize the clavicle and scapula with one hand and grab the head of the humerus with your other hand and bring it into the normal position relative to the glenoid.
With many patients, the head of the humerus will rather be positioned a bit anteriorly.
During the load portion of the test, push the head of the humerus anteriorly in order to test for anterior laxity and posteriorly for posterior laxity.

The test is positive if you can reproduce the patient’s symptoms and if the tested side clearly translates further than the other side.
A Translation of up to 25% of the humeral head diameter is considered normal anteriorly, 50% is considered normal posteriorly.
Some authors also grade the amount of translation from:
1 – which means translation up to, but not beyond, the glenoid rim,
2 – the head feels as if it is gliding riding over the glenoid rim, but spontaneously reduced
3 – which means subluxation without spontaneous reduction

 It is important to notice that anterior laxity is usually accompanied by tightness of the posterior capsule and vice versa.

Other common orthopedic tests to assess shoulder instability are:

Apprehension Test (Anterior Shoulder Instability)

Relocation Test (Anterior Shoulder Instability)

Release / Surprise Test (Anterior Shoulder Instability)

Sulcus Sign (Inferior Shoulder Instability)

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Morey VM, Singh H, Paladini P, Merolla G, Phadke V, Porcellini G. The Porcellini test: a novel test for accurate diagnosis of posterior labral tears of the shoulder: comparative analysis with the established tests. Musculoskeletal surgery. 2016 Dec;100(3):199-205.

Eshoj H, Ingwersen KG, Larsen CM, Kjaer BH, Juul-Kristensen B. Intertester reliability of clinical shoulder instability and laxity tests in subjects with and without self-reported shoulder problems. BMJ open. 2018 Mar 1;8(3):e018472.