Anterior Drawer Test (Shoulder)

The Anterior Drawer Test of the shoulder is a clinical examination used to evaluate anterior shoulder instability¹. Originally described in 1984, it is particularly useful when the results of other tests, such as the Apprehension Test, are difficult to interpret.

Purpose

The primary purpose of the test is to identify anterior shoulder instability, especially in patients where surgical treatment has failed.It is also indicated in patients with aching shoulder pain where the Apprehension Test provides inconclusive results².

A unique advantage of the Anterior Drawer Test is that it can reliably detect anterior subluxations, even when the Apprehension Test is negative.

Technique

Patient position:

• The patient lies supine on the examination table.

Examiner position:

• The examiner stands facing the affected shoulder.

• The patient’s hand is placed under the examiner’s axilla with the arm adducted.

• The patient is encouraged to maintain a relaxed grip.

Shoulder positioning:

• Shoulder abducted to 80–120°.

• 0–20° forward flexion.

• 0–30° lateral rotation.

• This position should not cause discomfort for the patient.

Scapular stabilization:

• The examiner stabilizes the scapula with the opposite hand.

• The index and middle finger are placed on the scapular spine, while the thumb applies counterpressure on the coracoid process.

Anterior translation of the humeral head:

• The examiner uses the free hand to apply an anterior glide of the humeral head.

Positive test:

• Increased anterior translation compared with the contralateral side indicates anterior instability.

• A clicking sound may indicate a labral tear or the humeral head gliding over the glenoid rim⁴.

Grading of Test Results³

Grade	Interpretation
0	Minimal displacement
1	Humeral head reaches glenoid rim
2	Humeral head dislocates but relocates spontaneously
3	Humeral head does not relocate spontaneously

Diagnostic Accuracy

Clinical studies have reported the following diagnostic values⁶:

Parameter	Value	Clinical Meaning
Sensitivity	0.53	Moderate ability to identify instability
Specificity	0.85	Good ability to exclude instability in healthy shoulders
Positive LR	3.6	Moderate evidence of instability when positive
Negative LR	0.57	Limited ability to rule out instability when negative

This makes the Anterior Drawer Test most useful for confirming traumatic anterior instability, provided that pain does not prevent test execution⁶.

Clinical Relevance

• Valuable for assessing anterior shoulder instability, particularly after inconclusive Apprehension Test results.

• Detects anterior subluxations even when other tests are negative.

• Provides a grading system that helps distinguish the severity of instability.

• Most useful when integrated into a comprehensive test battery (e.g., Apprehension Test, Relocation Test, Crank Test).

Summary

• The Anterior Drawer Test is a reliable method for detecting anterior instability and subluxation.

• Grading system (0–3) allows differentiation of severity.

• Shows moderate sensitivity but high specificity, making it more useful for confirmation than screening.

• Particularly relevant in patients with failed surgery or chronic shoulder pain.

References

1. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.

2. Bakhsh W, Nicandri G. Anatomy and physical examination of the shoulder. Sports medicine and arthroscopy review. 2018 Sep 1;26(3):e10-22.

3. 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.

4. 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

5. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.

6. Shoulder - Anterior Drawer Test. Physiotherapy University College Copenhagen. Available from: https://youtu.be/G8s_7Q5zfTM%7C300

7. 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