Skip to Main Content

++

  • GH instability
  • Anterior or anterior-inferior GH instability
  • Posterior GH instability
  • Multidirectional GH instability

++

  • 831.00 Closed dislocation of shoulder

++

  • S43.006 Unspecified dislocation of unspecified shoulder joint
  • M25.311 Other instability, right shoulder

++
++

Description

++

  • 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

++

Essentials of Diagnosis

++

  • 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

++

General Considerations

++

  • 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

++

Demographics

++

  • 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

++

Signs and Symptoms

++

  • Specific signs and symptoms depend on onset, degree, frequency, direction, and associated pathology of the injury
  • Pain in shoulder; location often ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.