Shoulder Orthopaedic Test: Load and Shift

The Load and Shift test is a clinical test used to assess the stability of the glenohumeral joint, specifically for anterior and posterior instability. The test involves applying a force to the humeral head and moving it anteriorly and posteriorly relative to the glenoid fossa.

Here are the general steps for performing the Load and Shift test:

1. The patient is seated or supine with the arm at the side and the elbow flexed to 90 degrees.
2. The examiner stands behind the patient and places one hand on the scapula to stabilize it while the other hand grasps the humeral head.
3. The examiner then applies a force to the humeral head to move it anteriorly and posteriorly while observing for any translation or subluxation of the joint.
4. The examiner grades the amount of anterior and posterior translation using a grading system from 0 to 3. A score of 0 indicates no translation, while a score of 3 indicates gross instability.

The Load and Shift test can be modified to assess for inferior and superior instability as well, by moving the humeral head in a downward or upward direction while stabilizing the scapula.

The Load and Shift test is not typically reported in terms of sensitivity and specificity as it is a clinical test used to assess the stability of the glenohumeral joint, rather than a diagnostic test used to detect a specific condition.

The interpretation of the test depends on the amount of translation observed during the test. Normally, there should be minimal or no translation of the humeral head in relation to the glenoid fossa. However, if the humeral head moves excessively or subluxes, it may indicate joint instability, which could be due to anterior, posterior, inferior, or superior instability. The severity of the instability is graded using a scoring system, typically ranging from 0 to 3.

References:

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