Gerber and Ganz describe anterior and posterior drawer tests of the shoulder, modeled on knee laxity testing. The goal is to identify the direction of glenohumeral instability before surgery. The paper argues this prevents the reconstruction failures that occur when posterior or multidirectional instability is missed.
When a shoulder reconstruction fails, ask whether the wrong direction of instability was treated. This paper's core teaching is that posterior and multidirectional instability are underdiagnosed, and that missing them is a leading cause of failed anterior repairs. In their own series, all 5 poor results after 56 anterior reconstructions had unrecognized posterior or multidirectional instability.
Build a directional mental model at the bedside. A positive apprehension test points anterior. A positive posterior drawer points posterior. A positive sulcus on inferior traction almost always means the problem is multidirectional.
Do not rely on symptoms alone. Four of five failures had posterior subluxation that was painful but never felt unstable, so a chronically aching, fatigable shoulder still warrants directional testing.
As a technique paper from a single center with small numbers, this is expert description rather than validated diagnostic accuracy, but the framework of grading instability by direction remains foundational.
Gerber and Ganz describe anterior and posterior drawer tests of the shoulder, modeled on knee laxity testing. The goal is to identify the direction of glenohumeral instability before surgery. The paper argues this prevents the reconstruction failures that occur when posterior or multidirectional instability is missed.
When a shoulder reconstruction fails, ask whether the wrong direction of instability was treated. This paper's core teaching is that posterior and multidirectional instability are underdiagnosed, and that missing them is a leading cause of failed anterior repairs. In their own series, all 5 poor results after 56 anterior reconstructions had unrecognized posterior or multidirectional instability.
Build a directional mental model at the bedside. A positive apprehension test points anterior. A positive posterior drawer points posterior. A positive sulcus on inferior traction almost always means the problem is multidirectional.
Do not rely on symptoms alone. Four of five failures had posterior subluxation that was painful but never felt unstable, so a chronically aching, fatigable shoulder still warrants directional testing.
As a technique paper from a single center with small numbers, this is expert description rather than validated diagnostic accuracy, but the framework of grading instability by direction remains foundational.