The Shoulder Lever Test – Technical Tip for Instability Assessment in Large Shoulders

INTRODUCTION: The classical shoulder tests for instability of the glenohumeral joint are the load and shift and drawer tests. Here, the humeral head is gripped between fingers and thumb to assess translation. This can be challenging to perform accurately in obese individuals and muscular athletes. TECHNICAL TIP: The shoulder and upper arm is utilized as a Class 3 lever. By fixing the patient’s elbow (fulcrum) and applying translational force on the humerus (force), the instability at the glenohumeral joint (load) can be accurately judged. The mechanical advantage of a Class 3 lever is utilized to generate maximal displacement at the glenohumeral joint by applying minimal translational force at the humerus. The translation can be graded with the modified Hawkins scale. CONCLUSION: The shoulder lever test obviates the need to grip the humeral head in obese and well-built individuals to accurately judge the translation at the glenohumeral joint, improving the clinical yield.