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Condition/Disorder Synonyms

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  • GH instability

  • Anterior or anterior-inferior GH instability

  • Posterior GH instability

  • Multidirectional GH instability

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ICD-9-CM Code

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  • 831.00 Closed dislocation of shoulder

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ICD-10-CM Codes

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  • S43.006 Unspecified dislocation of unspecified shoulder joint

  • M25.311 Other instability, right shoulder

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Preferred Practice Pattern

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Key Features

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Description

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  • Excessive and symptomatic translation of the humeral head in one or more directions

  • Instability may be associated with dislocation or subluxation associated with trauma

  • Glenohumeral instability may be secondary to atraumatic factors associated with structural, postural, or movement dysfunction or from recurrent minor injury to the structures of the glenohumeral joint2-4

  • Symptomatology and management varies based on onset, degree, frequency, direction, associated pathology, neuromuscular control, and premorbid activity level4

    • Anterior or anterior-inferior instability

      • Mechanism

        • 95% of traumatic shoulder instabilities4

        • May result in dislocation or subluxation

        • The humerus is forced into extreme abduction and external rotation, or horizontal abduction

        • Associated pathology includes Bankart lesion (anterior), humeral avulsion of glenohumeral ligaments (HAGL), and Hill-Sachs lesion5

      • Symptoms

        • Anterior and inferior shoulder pain

        • Instability and apprehension to abduction, external rotation, horizontal abduction motions

    • Posterior instability

      • Mechanism

        • 5% of traumatic shoulder instabilities4

        • May result in dislocation or subluxation

        • Fall on an outstretched arm, movements of extreme horizontal adduction or internal rotation

        • Associated pathology includes disruption of the posterior capsule, tearing of the teres minor, reverse Hill-Sachs lesion6

      • Symptoms

        • Posterior shoulder pain

        • Instability and apprehension to flexion, horizontal adduction, internal rotation

    • Multidirectional instability

      • Mechanism

        • May occur without episode of trauma, though patient may have a history of traumatic dislocation7

        • May result in dislocation or subluxation

        • Instability and apprehension present in multiple directions, though one direction may be the primary direction of instability

        • Associated pathology depends on primary direction of instability, duration of instability, history of trauma4,7

      • Symptoms

        • Pain and instability are often determined by the direction of primary instability and can vary based on activity

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Essentials of Diagnosis

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  • Diagnosis made primarily by clinical examination, though imaging often necessary to rule in or out associated pathology

  • Anterior instability is most common, followed by multidirectional, then posterior instability

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General Considerations

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  • Onset, degree, frequency, direction, associated pathology, neuromuscular control, and premorbid activity level dictate the diagnosis and management4

  • Interaction between glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular joints must be examined to determine optimal treatment plan8,9

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Demographics

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  • Young athletes most commonly affected7

  • Males more often affected than females by traumatic instability; inconclusive evidence for atraumatic or multidirectional

  • Multidirectional instability may be associated with gymnastics, swimming, weightlifting, and the individual may have increased joint laxity throughout the body7...

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