Evaluation of Recurrent Instability.

Last updated Friday, November 16, 2007

Figure 2

Figure 3

Figure 4

The history (atraumatic)

AMBRII history

Most patients presenting with AMBRII are under the age of 30 years (see figure 2). Because the instability manifests itself in mid range positions of the shoulder, atraumatic instability typically causes discomfort and dysfunction in ordinary activities of daily living. Commonly such patients have greatest difficulty sleeping, lifting overhead, and throwing (see table 1 and figure 3). Their general health status as revealed by the SF 36 is not as good on average as that of a comparable group of patients with traumatic instability (see figure 4).

The onset is usually insidious, but it may occur after a minor injury or period of disuse. The unwanted translations may range from a sensation of a minor "slip" in the joint to a complete dislocation of the humeral head from the glenoid. The displacement characteristically reduces spontaneously after which the patient is usually able to return to his or her activities without much pain or problem. As the condition progresses, the patient notices that the shoulder has become looser and may feel it slip out and clunk back in with increasing ease and in an increasing number of activities. The shoulder may become uncomfortable, even with the arm at rest. The patient may volunteer that he or she can make the shoulder "pop out" and that at times the shoulder feels as if it "needs to be popped out" on purpose.

It is important to document from the history the circumstances surrounding the onset of the problem as well as each and every position of the shoulder in which the patient experiences instability. It is also important to note if the opposite shoulder is symptomatic as well. A family history may reveal other kindred similarly affected as well as conditions know to predispose to atraumatic instability, such as Ehlers Danlos syndrome.

Many patients admit that they used to have a habit of dislocating the joint, but now they can no longer control the stability of the joint. The surgeon must determine if habitual dislocation remains a feature of the patients problem. It is obvious that it is difficult for surgery to cure habitual instability.

Finally, it is important to document the patient's expectations of their shoulder to assure that the goals are within reach before treatment is started.

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