Tests for Anterior Shoulder instability

               Tests for Anterior Shoulder instability 

Andrews' Anterior Instability Test.

⏩The patient lies supine with the shoulder abducted 130° and laterally rotated 90°.

⏩The examiner stabilizes the elbow and distal humerus with one hand and uses the other hand to grasp the humeral head and lift it forward ,

 A reproduction of the patient's symptoms gives a positive test for anterior instability. If the examiner hears a clunk.

an anterior labral tear may be present. This test is a modification of the load and shift test.

 Anterior Drawer Test of the Shoulder.

⏩The patient lies supine.

⏩The examiner place the hand of the affected shoulder in the examiner's axilla, holding the patient's hand with the arm so that the patient remains relaxed.

The shoulder to be tested is abducted between 80° and 120°, forward flexed up to 20°, and laterally rotated up to 30°.

The examiner then stabilizes the patient's scapula with the opposite hand, pushing the spine of the scapula forward with the index and middle fingers.

The examiner's thumb exerts counterpressure on the patient's coracoid process. Using the arm that is holding the patient's hand, the examiner places his or her hand around the patient's relaxed upper arm and draws the humerus forward.

 The movement may be accompanied by a click, by patient apprehension, or both. The amount of movement  available is compared with that of the normal side.

A positive test indicates anterior instability  depending on the amount of anterior translation.

The click may indicate a labral tear or slippage of the humeral head over the glenoid rim. This test is a modification of the load and shift test.

Anterior Instability Test (Leffert's Test).

⏩ The exam stands behind the shoulder being examined while the patient sits.

⏩The examiner places his or her near hand over the shoulder so that the index finger is over the head of the humerus anteriorly and the middle finger is over the coracoid process.

⏩The thumb is placed over the posterior humeral head. 

The examiner's other hand grasps the patient's wrist and carefully abducts and laterally rotates the arm 

. If, on movement of the arm, the finger palpating the anterior humeral head moves forward, the test is said to be positive for anterior instability.

Normally, the two fingers remain in the same plane. With a positive test, when the arm is returned to the starting position, the index finger returns to the starting position as the humeral head glides backward.