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Condition/Disorder Synonyms

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

ICD-9-CM Code

• 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 Dysfunction1

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 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 ...