The Load and Shift Test is a commonly used diagnostic tool to assess anterior and posterior shoulder instability. It provides insights into the mobility of the shoulder joint and helps identify potential instability issues.
How to Perform the Load and Shift Test
Positioning the Patient
- Have the patient lie comfortably in a supine position.
- The therapist stands beside the patient, using one hand to stabilize the scapula against the thorax.
Placement of the Therapist’s Hands
- The therapist places their hand over the glenohumeral joint line and humeral head.
- The little finger should rest along the anterior glenohumeral joint line and humeral head.
Loading the Joint
- Carefully push the humerus anteriorly or posteriorly to seat it properly in the glenoid fossa. This step is referred to as the “load” phase of the test.
Shifting the Humerus
- To assess anterior stability, translate the humeral head in an anteromedial direction.
- To evaluate posterior stability, shift it in a posterolateral direction.
- Observe the amount of translation and the quality of the end feel.
- Always compare the results with the contralateral (unaffected) side for accuracy.
Grading the Load and Shift Test
The test is graded based on the amount of anterior translation observed:
- Grade 0: Minimal or no movement.
- Grade 1: The humeral head slides up the glenoid slope but does not pass over the rim.
- Grade 2: The humeral head glides over the glenoid rim but returns to its position spontaneously when stress is removed.
- Grade 3: The humeral head moves over the rim and remains dislocated even after removing stress.
Identifying a Positive Test
The Load and Shift Test is considered positive if:
- The patient’s symptoms are reproduced.
- The tested shoulder exhibits significantly more translation compared to the opposite side.
Normal translation ranges:
- Anteriorly: Up to 25% of the humeral head diameter.
- Posteriorly: Up to 50% of the humeral head diameter.
Translation Grades for Load and Shift Test
Grade 1: Translation occurs up to, but not beyond, the glenoid rim.
Grade 2: The humeral head moves over the glenoid rim but spontaneously reduces.
Grade 3: Subluxation occurs, and the humeral head does not return to its position.
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