The Norwood Stress Test assesses anterior shoulder laxity through passive anterior translation of the humeral head. It helps identify instability tendencies but does not confirm structural injury.
Shoulder instability involves passive capsular restraint, active muscular control and load tolerance working together.
The Norwood Stress Test applies controlled anterior force to assess how well the shoulder resists anterior translation.
It is best used as part of an instability cluster rather than a standalone test.
A positive result may suggest instability tendency but does not confirm pathology.
Primary purpose: Assess anterior shoulder stability
Body region: Shoulder
Commonly associated with: Anterior instability
Positive finding: Excessive translation or symptom reproduction
Negative finding: Stable, controlled end-feel
Clinical role: Supports instability assessment reasoning
Best used with: Load and Shift + Apprehension tests
It is a passive test where anterior force is applied to the humeral head while stabilising the scapula.
It is used to assess passive anterior restraint and symptom response.
It may help assess:
suspected shoulder instability
capsular laxity
instability risk in athletes
changes in shoulder stability over time
anterior glenohumeral translation
capsular restraint
symptom reproduction
side-to-side differences
Useful for:
exercise professionals
strength and conditioning coaches
rehab practitioners
movement educators
Use when there is:
history of shoulder instability
feeling of slipping or giving way
apprehension in pressing or throwing
recurrent shoulder symptoms
Avoid in:
acute trauma
post-surgical restrictions
high pain or guarding
suspected dislocation
Stop if:
pain increases significantly
strong instability sensation occurs
None required.
Client is relaxed in supine or seated position with shoulder slightly abducted.
Examiner stabilises scapula and applies controlled anterior force to the humeral head.
Observe:
translation quality
symptom reproduction
end-feel
side comparison
Positive finding: excessive translation or instability symptoms.
Negative finding: firm control and no symptoms.
Positive result may mean:
Possible anterior shoulder instability or capsular laxity, especially with supporting history and tests.
Negative result may mean:
Better passive stability, but dynamic instability can still exist.
It does not confirm or exclude structural injury on its own.
Evidence for this specific test is limited.
It does not have well-established sensitivity, specificity or likelihood ratios in high-quality modern studies.
Because of this:
it should not be used in isolation
it is best interpreted in a cluster
clinical history is essential
Reliability depends on consistent force application
Interpretation can vary between examiners
Validity improves when used with other instability tests
Limited standalone diagnostic strength
Errors:
inconsistent force
poor scapular stabilisation
over-interpreting mild differences
not comparing sides
Limitations:
subjective grading
limited diagnostic accuracy evidence
overlap with neuromuscular control issues
instability screening
return-to-sport decisions
monitoring shoulder stability changes
guiding load progression
part of instability test cluster
Record:
Test name
Side tested
Result (positive / negative / unclear)
Translation description
Pain score (0–10)
Symptom reproduction
End-feel quality
Comparison side
Irritability level
Compensations
Related findings
Notes on interpretation
Load and Shift Test
Apprehension Test
Relocation Test
Sulcus Sign
Scapular Control Assessment
What does the Norwood Stress Test assess?
Shoulder stability under anterior stress.
Does it confirm instability?
No. It only suggests possible instability.
What is a positive result?
Excessive movement or reproduction of instability symptoms.
Should it be used alone?
No. It should be part of a test cluster.
Is it reliable?
Reliability depends on technique consistency.
What does the Norwood Stress Test assess?
Anterior shoulder stability under passive stress.
Does it confirm instability?
No. It only suggests possible instability and must be combined with other findings.
What does a positive result mean?
It may indicate increased anterior laxity or instability tendency.
What does a negative result mean?
It may suggest better passive stability, but does not rule out dynamic instability.
Should it be used alone?
No. It should always be part of an instability test cluster.
How strong is the evidence?
Evidence for diagnostic accuracy is limited, so results should be interpreted cautiously.
What is its main value?
Supporting clinical reasoning through pattern recognition, not diagnosis.
Hegedus, E. J., et al. (2018–2022). Diagnostic accuracy of shoulder special tests: systematic review updates. British Journal of Sports Medicine.
Lewis, J. (2021–2023). Shoulder pain and instability clinical reasoning updates. British Journal of Sports Medicine.
Kibler, W. B., et al. (2013). Shoulder instability and scapular mechanics in overhead athletes. British Journal of Sports Medicine.
