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166: GLENOHUMERAL JOINT INSTABILITY

Steven B. Ambler, DPT, PT, OCS

CONDITION/DISORDER SYNONYMS

  • GH instability

  • Anterior or anterior-inferior GH instability

  • Posterior GH instability

  • Multidirectional GH instability

ICD-9-CM CODE1

  • 831.00 Closed dislocation of shoulder

ICD-10-CM CODES

  • S43.006 Unspecified dislocation of unspecified shoulder joint

  • M25.311 Other instability, right shoulder

PREFERRED PRACTICE PATTERN

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction2

PATIENT PRESENTATION

A 19-year-old patient is being seen in the clinic with a chief complaint of right anterior shoulder pain that began after a shoulder dislocation 1 week ago. He states that he injured the shoulder while sustaining a direct blow to the arm playing semipro football and that the dislocation did require relocation in the emergency room. Patient has been wearing a sling since the injury and was given a shoulder stabilizer brace to wear during football. The patient is taking Naproxen and has no pain at rest at this time. He does have 4–5/10 pain when he wakes in the morning and when he has to reach overhead. He denies numbness and tingling and has no other complaints at this time. The patient is currently not practicing and is keeping the arm in the sling. He is left handed and would like to be able to return to his team this season where he plays quarterback.

KEY FEATURES

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 joint3,4

  • Symptomatology and management vary 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 ...

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