Purpose of Anterior Drawer Test (anterior glenohumeral instability): To test if there is an anterior instability of the glenohumeral joint.

Patient position: Supine lying.

Examiner position: Stand facing the patient’s affected side.

Procedure:

Place the patient’s affected shoulder just over edge of the examination table. Assuming the patient’s left shoulder is being tested, fix the patient’s left hand in the examiner’s right axilla by adducting the examiner’s right humerus (1).

The patient should not grasp the examiner’s axilla but should be completely relaxed (1).

Hold the patient’s affected shoulder in 80 to 120 degrees of abduction, 0 to 20 degrees of forward flexion, and 0 to 30 degrees of lateral rotation (1).Hold the patient’s left scapula with your left hand, pressing the scapular spine forward with your index and middle fingers; while your thumb exerts counter-pressure on the coracoid process (1).

Grasp the patient’s relaxed upper arm (humerus) using your right hand and draw the humeral head anteriorly with a force comparable to that used at the knee in Lachman’s test (1).

Outcome:

The amount of translation between the fixed scapula and the movable humerus can be appreciated and graded as with anterior knee joint instability (1).

This test is positive if there is an excessive anterior translation of the humeral head. An occasional audible click on forward movement of the head of humerus (usually associated with apprehension) may indicate labral pathology.

Additional Notes:
Procedure for modified anterior drawer test for shoulder joint:

With the patient in supine lying, place the patient’s affected shoulder just over the edge of the examination table (2). Hold the patient’s wrist with one hand and the patient’s relaxed upper arm (humerus) with the other hand (2). Place the patient’s affected arm in 60 to 80 degrees of abduction, and 0 degrees of rotation (2).

Apply a slight axial load to the patient’s affected shoulder and then translate the humeral head anteriorly over the glenoid rim (1-3).

Outcome:

The amount of translation of the humeral head over the glenoid can be measured with a modified version of the classification by Hawkins and Bokor (2, 4). This test is positive if there is an excessive anterior translation of the humeral head. The patient’s symptoms of instability may be reproduced on grades II and III.

Grades of Glenohumeral Translation for the modified anterior drawer test (2):

Grade	Descriptors
I	Humeral head riding up to the edge of the glenoid, but not over the glenoid rim
II	Humeral head riding over the edge of the glenoid, spontaneously relocates
III	Humeral head riding over the edge of the glenoid, remains dislocated when the examiner’s hand on the humerus was removed

Reference:

1. Gerber C, Ganz R. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. The Journal of bone and joint surgery British volume. 1984;66(4):551-6.
2. Farber AJ, Castillo R, Clough M, Bahk M, McFarland EG. Clinical assessment of three common tests for traumatic anterior shoulder instability. JBJS. 2006;88(7):1467-74.
3. Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clinical orthopaedics and related research. 1993(291):7-19.
4. McFarland EG, Torpey BM, Curl LA. Evaluation of shoulder laxity. Sports medicine (Auckland, NZ). 1996;22(4):264-72.