Intermediate Shoulder Instability.
Last updated Friday, January 28, 2005
Evaluation and managementExamination and tests When there has been an initiating injury, it is essential to
determine the position of the arm and the direction and magnitude of
the force producing the injury so that the likelihood of a capsular
tear can be determined. Unless this is clearly the case, the default
assumption is that the shoulder has become dysfunctional without a
substantial anatomic lesion, and therefore needs to be managed with a
rehabilitative approach emphasizing strength, balance, endurance, and
good technique.
Unless a functionally significant instability can be determined on
history and physical examination, the emphasis on rehabilitation must
continue. When the history and physical examination do not indicate the
nature of the functional instability "studies" such as contrast CT,
MRI, examination under anesthesia, and arthroscopy are unlikely to be
helpful in determining the treatment. "Findings" on these tests, such
as "increased translation," "a large axillary pouch," or "labral
fraying" may be identified even in functionally normal shoulders and as
such may have no relation to the patient's functional problem. The
risk, therefore, is that findings on these tests may distract the
clinician from findings on history and physical examination. Unless the
functional instability can be rigorously characterized by the history
and physical examination, it is unlikely that surgical treatment will
be curative. Management techniques The history and physical examination constitute the most efficient and
cost effective mechanisms for identifying treatable problems of
glenohumeral instability. When these clinical tools do not clearly
define the nature of the patient's functional problem, management by
techniques other than physical rehabilitation and activity modification
are unlikely to be effective. Using this approach, the need for
expensive diagnostic approaches in cases of suspected instability is
reduced to a minimum and surgery is reserved for those who can most
benefit from it. This highly selective approach improves the overall
results of surgical treatment of instability by helping to avoid the
situation where a well-done operation fails to restore the patient's
function.Disclaimer
This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.
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