Background: Shoulder disorders affect up to 67% of the adult population at some point in their lifetime. The shoulder complex ranks third, trailing low back and neck pain, in musculoskeletal disorders for which individuals seek physical rehabilitation. The assessment of shoulder stability is an integral component of the patient examination, as it may assist the clinician in making a diagnosis, measuring improvement or deterioration, and determining functional impairments. Reliable tests and measurements are therefore essential to both the clinician and researcher desiring to objectively monitor disease progression, outcomes, and mobility impairments. Many of the currently used clinical tests for anterior instability are documented based on a dichotomous outcome, thus do not provide a means of quantifying or ranking the degree of anterior translation associated with the instability. The load and shift test has been described in textbooks and research investigations as a method to quantify (rank) anterior shoulder instability and/or translation at the glenohumeral joint. This test is attractive clinically, as it requires no special equipment or space, thus may be utilized in multiple settings and without cost; however, few studies have investigated the interrater reliability of this test. Purpose: The purpose of this investigation was to determine the interrater reliability of the seated load and shift test using a 4-level grading criteria. Method: Two investigators performed the load and shift test on the non-dominant shoulder of 29 asymptomatic female participants in a repeated measures intrasession design. Each investigator was blinded to the results and the order of testing was counterbalanced to minimize potential bias. Results: Results indicated good interrater reliability with an Intraclass Correlation Coefficient (2, 1) (95% CI) = 0.80 (0.61, 0.90). Conclusion: The load and shift test appears to be a reliable clinical test for detecting and quantifying anterior translation of the glenohumeral joint when using the grading criteria outlined in this investigation. Shoulder translation when excessive is associated with shoulder instability, thus this test may prove valuable as a measurement of anterior instability. Recommendations: Future investigations are needed to determine the reliability and validity of this test among a symptomatic population and including a male cohort.
Kolber MJ, Carrao M. The Interrater Reliability of the Load and Shift Test for Anterior Shoulder Instability: A Technical Report. The Internet Journal of Allied Health Sciences and Practice. 2010 Apr 01;8(2), Article 10.