Load and Shift Test

The Load and Shift Test is used to evaluate the stability of the glenohumeral joint (GH joint) by assessing the anteroposterior translation of the humeral head. It is particularly helpful in identifying joint laxity, subluxation, or instability in patients with recurrent dislocations or chronic shoulder complaints.

Technique

Patient Position

• The patient sits with the arm relaxed in their lap.

• Alternatively, the test can be performed with the patient in a supine position.

Hand Placement

• One hand of the examiner stabilizes the scapula against the thorax.

• The other hand is positioned with the web space between the thumb and index finger over the acromion, while the fingers align along the GH joint line.

Execution

• The examiner grips the humeral head and applies an anteromedial force to assess anterior stability.

• A posterolateral force is then applied to evaluate posterior stability.

Interpretation

• Normal anterior translation: Less than 50% of the humeral head diameter.

• Abnormal translation (positive test): More than 50% anterior or posterior translation → indicates laxity or instability.

Diagnostic Accuracy

Parameter	Anterior Instability	Posterior Instability
Sensitivity	50%⁴	14%⁴
Specificity	100%⁴	100%⁴
Sensitivity (Gerber & Ganz, recurrent dislocations)	100%⁵	–

High specificity (100%) → A positive test strongly confirms shoulder instability.Moderate to low sensitivity → A negative test does not rule out instability.

Clinical Relevance

• The Load and Shift Test is frequently combined with other stability assessments to improve diagnostic precision:

  • Apprehension Test – for anterior instability

  • Jerk Test – for posterior instability

  • Sulcus Sign – for multidirectional instability

  If instability is suspected, dynamic testing and imaging methods such as MRI, X-ray, or arthrography should be considered.

  
  

  Summary

  The Load and Shift Test is an effective clinical maneuver for assessing anteroposterior glenohumeral stability.

  • Strengths: High specificity → A positive finding reliably indicates instability.

  • Limitations: Low sensitivity → A negative test does not rule out pathology.

  • Best practice: Always interpret in combination with other clinical tests for a comprehensive evaluation.

  
  

  References

¹ Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention. 2nd ed. McGraw-Hill.

² Clinically Relevant Technologies. Load and Shift Test. YouTube. Available from: http://www.youtube.com/watch?v=zuf09YtD_Kk

³ Clinically Relevant Technologies. Posterior Load and Shift Test. YouTube. Available from: http://www.youtube.com/watch?v=uhBWu9TJsJ8

⁴ Valencia Mora M, Ibán MÁR, Heredia JD, et al. Physical Exam and Evaluation of the Unstable Shoulder. Open Orthop J. 2017;11:946–956.

⁵ Gerber C, Ganz R. Clinical assessment of instability of the shoulder. J Bone Joint Surg Br. 1984;66B:551.