Question:My twin daughters were both involved in a snowmobile accident. They both injured their shoulder. When I read the doctor's report it said there was a "positive crank test" for one girl and a negative "load and shift test" for both. Can you tell me what this means?
Both of these tests are used to look for shoulder instability. In the load and shift test, your daughter would be sitting up straight. The doctor places one hand over the top of the shoulder to stabilize the scapula (shoulder blade). The other hand grasps the top of the humerus (upper arm bone) where the bone inserts into the shoulder socket.
The humerus is shifted forward and back. The doctor looks and feels for the amount of shifting in each direction. This test helps the examiner tell how loose or lax the joint is. Too much or not enough motion in one direction is diagnostic of shoulder instability.
The joint may not be dislocated but the ligaments and capsule around the shoulder may be stretched from the injury. In such cases the shoulder shifts farther in one direction compared to the other. For someone who has loose ligaments in general, the amount of shift will be equal from one direction to the other.
The crank test is also known as an "apprehension" test. It also tests for instability problems, usually caused by trauma. The patient is lying on her back with the arm out to the side and the elbow bent. The hand is moved back like a crank toward the ear on the same side.
A positive test is a look of alarm on the patient's face. The patient will not want the arm to be cranked back any further. The patient says it feels like the arm is going to pop out (dislocate). There may be a painful click in the shoulder during the movement. A positive crank test suggests there may be a tear of the labrum in the shoulder. That's the rim of cartilage around the edge of the socket that helps hold the head of the humerus in the socket.
You may want to discuss the test results and treatment suggested if you haven't already done so.Naoko Mizuno, MD, et al. Recurrent Anterior Shoulder Dislocation Caused by a Midsubstance Complete Capsular Tear. In The Journal of Bone and Joint Surgery. December 2005. Vol. 87-A. No. 12. Pp. 2717-2723.
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