LOAD AND SHIFT TEST

​• ​Test positioning

The patient sits with no upper trunk stabilization and the involved arm resting at the side.

The therapist stands slightly behind the patient while stabilizing the clavicle and scapula with one hand.

With the other hand, the therapist grasps the patient's humeral head with the thumb posteriorly.

The therapist's remaining fingers are located anteriorly.

​• ​Action

The therapist places an axial load along the shaft of the humerus (load) in an attempt to compress the humeral head into the glenoid fossa.

With the load applied, the therapist translates the humeral head, first anteriorly (shift) and then posteriorly (shift).

​• ​Positive finding

An anterior or posterior translation of the humeral head greater than 25% of the diameter of the humeral head when a load is applied is considered to be a positive test.

The test should be repeated bilaterally for comparative findings.

​• ​Special considerations & comments

​Translation between 25% and 50% has been described as being a grade I positive test.

Greater than 50% translation associated with a subsequent reduction of the humeral head is considered grade II, while the same amount of translation without reduction is recognized as grade III and the most serious type of a shift.

The Load and Shift Test is attributed to the work of Dr. James Andrews and Dr. John C. Kennedy, whose contributions to the understanding of shoulder joint mechanics and instability have been crucial in the development of this assessment.