Hello Surgeon

X

How can we help you today?

Special Test

Anterior Drawer of the Shoulder

Anterior Drawer test of the shoulder (or Gerber–Ganz Anterior Drawer Test) is used in diagnosis of anterior instability of the shoulder.

How it’s Performed?

  • The patient is supine with the affected shoulder positioned such that it projects slightly past the edge of the examining table.
  • The affected shoulder is held in 80 to 120° of abduction, 0 to 20° of flexion, and 0 to 30° of external rotation as loosely and as painlessly as possible.
  • The examiner immobilizes the scapula with the left hand (with the index and middle fingers on the scapular spine and the thumb on the coracoid).
  • With the right hand, the examiner tightly grasps the patient’s proximal upper arm and pulls it anteriorly in a manner similar to the Lachman test for anterior instability in the knee.
Read Also: Lachman Test

What does a positive Anterior Drawer Test mean?

Anterior Drawer test of the shoulder considered positive in these situation:

  1. The relative motion between the immobilized scapula and the anteriorly displaced humerus is a measure of anterior instability and can be specified in degrees.
  2. Occasional audible clicking with or without pain can indicate an anterior labral defect.

Sensitivity & Specificity

A study by Adam J Farber 1 for a clinical assessment of three common tests for traumatic anterior shoulder instability (apprehension test, relocation test and  anterior drawer test), he found that anterior drawer test (when pain does not prevent it from being performed) is helpful for diagnosing traumatic anterior instability. The accuracy was as following:

  • Sensitivity: 53 %
  • Specificity: 85 %

Diagnostic Utility of the Anterior Drawer Test in Identifying Shoulder Instability:

Test and Study QualityPopulationReference StandardSensSpec+LR-LR
Anterior drawer test (pain)363 patients scheduled to undergo shoulder surgeryEither radiographic documentation of an anterior shoulder dislocation after trauma or demonstration of a Hill-Sachs lesion, a Bankart lesion, or a humeral avulsion of the glenohumeral ligament at the time of arthroscopy.28.711.01.01
Anterior drawer test (instability symptoms)363 patients scheduled to undergo shoulder surgeryEither radiographic documentation of an anterior shoulder dislocation after trauma or demonstration of a Hill-Sachs lesion, a Bankart lesion, or a humeral avulsion of the glenohumeral ligament at the time of arthroscopy.56.853.60.56

Notes

  • Anterior instability of the G-H joint is the most common direction of instability.
  • Repetitive overhead activities such as throwing can lead to microtrauma at the shoulder, leading to eventual breakdown of both the static and dynamic stabilizers of the joint, or G-H instability.
  • The mechanism for an anterior dislocation is abduction, external rotation, and extension and is common in throwing and racquet sports, gymnastics, and swimming.
  • Following an acute trauma, the patient typically complains of severe pain and a sense that the shoulder is out.
  • The humeral head will be palpable anteriorly and the posterior shoulder will exhibit a hollow beneath the acromion.
  • In younger age groups (approximately 25 years and younger), the chance of recurrent anterior dislocation after the initial event is greater than 95% 2.
  • Recurrences are rare in patients older than 50 years of age 3.
  • When anterior instability is suspected, the clinician should assess for tightness of the posterior capsule. Posterior capsule tightness has been shown to accentuate anterior translation and superior migration.361 Loss of IR in young patients may be an important finding suggestive of posterior capsular contracture that is often associated with subtle instability. The posterior joint glide is also restricted.
  • Symptoms also include varying degrees of instability, transient neurologic symptoms, and easy fatigability. Warner et al.4 reported a lower IR to-ER ratio for peak torque and total work in the dominant shoulder of patients with instability as compared with healthy controls. This suggests that an association exists between relative IR weakness and anterior instability.
Read Also: Anterior Shoulder Instability
Anterior shoulder dislocation
Anterior Shoulder Dislocation

Reference

  1. 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. PMID: 16818971.
  2. Hovelius L, Eriksson K, Fredin H, et al: Recurrences after initial dislocation of the shoulder. J Bone Joint Surg [Am] 65:343–349, 1983.
  3. Rowe CR, Sakellarides HT: Factors related to recurrences of anterior dislocations of the shoulder. Clin Orthop 20:40, 1961.
  4. Warner JJP, Micheli LJ, Arslanian LE, et al: Patterns of flexibility, laxity, and strength in normal shoulders and shoulders with instability and impingement. Am J Sports Med 18:366–375, 1990.
  5. Clinical Tests for the Musculoskeletal System 3rd Edition.
  6. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

Last Reviewed
June 2, 2023
Contributed by
OrthoFixar

Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.

Angle Meter App for Android & iOS
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Orthopedic FRCS VIVAs Quiz
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Top 12 Best Free Orthopedic Apps
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
All-in-one Orthopedic App
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase