Load and Shift
Original Editor - Tyler Shultz
Top Contributors - Admin, Rachael Lowe, Tyler Shultz, Kim Jackson, Dan Rhon, WikiSysop, Pacifique Dusabeyezu, Tony Lowe, Evan Thomas, Naomi O'Reilly, Kai A. Sigel and Wanda van Niekerk
Purpose
This test is used to assess the stability of the Glenohumeral joint.
Technique
The patient should be seated. The therapist stabilizes the scapula to the thorax with one hand. In contrast, the other hand is placed across the posterior GH joint line and humeral head, and the web space is across the patient's acromion. The index finger should the over the anterior GH joint line. The clinician should now apply a "load and shift" of the humeral head across the stabilized scapula in an anteromedial direction to assess anterior stability, and in a posterolateral direction to assess posterior instability. Normal motion anteriorly is half of the distance of the humeral head, more movement is considered to be a sign of GH joint laxity.[1]
Evidence
This test has not been validated using biomechanical techniques. Tzannes and Murrell reported a sensitivity of 50% for anterior instability and 14% for posterior instability, while the specificity was 100% for both types.[4]
Gerber & Ganz also reported this test to be 100% sensitive for detecting instability in patients with recurrent dislocation, but not subluxation.[5]
References
- ↑ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
- ↑ Clinicially Relevant Technologies, http://www.youtube.com/watch?v=zuf09YtD_Kk; Accessed May 2011
- ↑ Clinically Relevant Technologies, http://www.youtube.com/watch?v=uhBWu9TJsJ8; Accessed May 2011
- ↑ Valencia Mora M, Ibán MÁR, Heredia JD, Gutiérrez-Gómez JC, Diaz RR, Aramberri M, Cobiella C. Physical Exam and Evaluation of the Unstable Shoulder. Open Orthop J. 2017 Aug 31;11:946-956.
- ↑ Gerber, C., Ganz, R. (1984) Clinical assessment of instability of the shoulder. J Bone and Joint Surg. 66B:551.