Load And Shift Test

Also known as the push-pull test

Indication: Used to assess AP humeral head translation

Test Procedure: Patient is seated, examiner is to the side and posterior to patient. The stabilizing arm is placed over the scapula posteriorly with the hand cupping the superior shoulder and the fingers on the coracoid process. The hand grips the head of the humerus and a medial compressive force is applied (Load portion of test). The examiner then applies a anteromedially directed translation force along the surface of the glenoid. After the anteriormedial translation is assessed, the compressive force is reapplied and the humeral head is transated posterolaterally along the line of the joint.

Evidence

  • Borsa et al (1999) used instrumental testing and found anterior translations of 8.0 mm an 6.0 mm of posterior translation.
  • Litner et al (1996) found laxity of up to grade II Altchek classification in any direction, including inferiorly, in normal healthy shoulders of NCAA division I althletes
  • Hawkins et al (1996) tested normal subjects, patients with MDI, and patients with anterior glenohumeral joint instability under general anesthesia using percent width of humeralhead that could be translated
    • Normal: anterior 17%; posterior 26%; inferior 29%
    • Anterior instability: anterior 29%, posterior 21%; inferior 40%
    • MDI: anterior 28%; posterior 52%; inferior 46%
  • Validity
    • Tzannes and Murrell (2002) found 50% sensitivity and 100% specificity for anteror direction and 14% sensitivity and 100% specificity for the posterior direction
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