Jump to content

Anterior Drawer Test Of The Shoulder

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed, Safiya Naz, Kim Jackson, Vidya Acharya and Mmesoma Eyisi

Introduction

The Anterior Drawer Test of the shoulder is a physical examination test used to test for shoulder instability.[1] It was first described in 1984 by

Purpose

Anterior Drawer Test of the shoulder examines the Anterior shoulder instability helping eliminate some failures of operative treatment. It is also used on aching shoulders where the apprehension test is difficult to interpret. Also, it allows reliable diagnosis of anterior subluxations even in patients who have a negative apprehension test. [2]

Technique

The technique for Anterior drawers test of the shoulder includes [2]

Step1. The patient is in a supine position.

Step2. The Therapist stands facing the affected shoulder (right shoulder as an example), fixing the patient's right hand under his left arm(axilla) with his humerus adducted. The patient's grasp should not be tight but relaxed.

Step3. The Patient's shoulder should be in 80 and 120 degrees of abduction, 0 to 20 degrees of forward flexion, and lateral rotation 0 to 30 degrees. All positions should be comfortable.

Step4. The Therapist stabilizes the patient's scapula with the opposite hand (right hand) by pushing the spine of the scapula with the index and middle finer. Applying counterpressure on the patient's coracoid process with the therapist thump.

Step5. The Therapist draws the patient's humerus forward (anteriorly) using his left hand.

Step6. A positive test indicates the anterior instability decided by the amount of anterior translation which is accessible compared with the normal side.

[3]
Grade Diagnosis
grade 0 Minimal displacement
grade 1 Humeral head reaches glenoid rim
grade 2 Humeral head can be dislocated but spontaneously resolved
grade 3 Humeral head does not spontaneously reduce

The click may indicate a labral tear or slippage of the humeral head over the glenoid rim.[4]

[5]

Evidence

Sensitivity = 0.53

Specificity = 0.85

Positive likelihood ratio (+LR) = 3.6

Negative likelihood ratio (-LR) = 0.57[6]

The anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability.[6]


References

  1. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  1. ↑ Bakhsh W, Nicandri G. Anatomy and physical examination of the shoulder. Sports medicine and arthroscopy review. 2018 Sep 1;26(3):e10-22.
  2. ↑ 2.0 2.1 Gerber C, Ganz RE. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. The Journal of bone and joint surgery. British volume. 1984 Aug;66(4):551-6.
  3. ↑ Lizzio VA, Meta F, Fidai M, Makhni EC. Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017;10(4):434-441. doi:10.1007/s12178-017-9434-3
  4. ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  5. ↑ Shoulder - Anterior Drawer Test. Physiotherapy University College Copenhagen. Available from: https://youtu.be/G8s_7Q5zfTM%7C300
  6. ↑ 6.0 6.1 Farber AJ, Castillo R, Clough M, Bahk M, McFarland EG. Clinical assessment of three common tests for traumatic anterior shoulder instability. J Bone Joint Surg Am. 2006;88(7):1467-1474. doi:10.2106/JBJS.E.00594
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Anterior_Drawer_Test_Of_The_Shoulder&oldid=377309"