Push-Pull Test of the Shoulder

The Push-Pull Test represents a crucial clinical examination technique for evaluating posterior shoulder instability. This diagnostic maneuver provides healthcare practitioners with valuable insights into the integrity of the posterior capsulo-labral complex and helps identify patients at risk for posterior shoulder instability.

The Push-Pull Test of the Shoulder described by Matsen et al. in 1990, is a type of load and shift test designed to detect posterior shoulder instability.

How to perform the Push-Pull Test of the Shoulder?

The proper execution of the Push-Pull Test requires precise positioning and careful manipulation. Medical practitioners should follow these essential steps for optimal assessment:

• The patient is placed in a supine position on the examination table. The examiner then takes their position beside the patient, establishing proper hand placement for the maneuver.
• The practitioner grasps the patient’s wrist while simultaneously positioning the affected arm in 90 degrees of abduction combined with 30 degrees of forward flexion.
• The examiner’s other hand maintains contact over the proximal humerus, specifically near the humeral head.
• The examiner then pulls up on the arm at the wrist while pushing down on the humerus through its long axis with the other hand.

See Also: Glenohumeral Joint Anatomy

What does a positive Push-Pull Test mean?

Normally, 50% posterior translation can be accomplished. If more than 50% posterior translation occurs or if the patient becomes apprehensive or pain results, the examiner should suspect posterior instability.

At least two cadaveric studies have been performed to evaluate the Push-Pull Test with regard to its ability to produce posterior glenohumeral translation. We are unaware of any clinical studies that have assessed the diagnostic validity of the Push-Pull Test with regard to posterior instability or the presence of a pathologic lesion.

See Also: Anterior Shoulder Instability

References & More

1. Rockwood and FA . The shoulder. Philadelphia: Saunders; 1990. Matsen III. Glenohumeral instability. pp. 611–755. [Google Scholar]
2. Valencia Mora M, Ibán MÁR, Heredia JD, Gutiérrez-Gómez JC, Diaz RR, Aramberri M, Cobiella C. Physical Exam and Evaluation of the Unstable Shoulder. Open Orthop J. 2017 Aug 31;11:946-956. doi: 10.2174/1874325001711010946. PMID: 29114336; PMCID: PMC5646139. Pubmed
3. Rockwood CA. Subluxations and dislocations about the shoulder. In: Rockwood CA, Green DP, eds. Fractures in Adults. Philadelphia: JB Lippincott; 1984.