title: The unstable shoulder: recurring subluxation.
abstract: A review of operative repairs for recurring dislocation of the shoulder revealed that a significant proportion of these operations was being done for what could best be described as recurring subluxation of the shoulder. The presenting complaint was of the shoulder 'going out of joint', but no significant trauma was recalled, dislocation was never shown on the radiograph and none required manual reduction. The only physical finding was apprehension on external rotation of the shoulder in abduction. Radiographs were frequently normal and arthrography and cineradiography were not helpful in confirming anterior displacement. The most useful preoperative information was obtained by manipulation of the shoulder under general anaesthesia just before the surgical repair. In all instances anterior instability could be demonstrated. Of 99 Magnuson-Stack repairs drawn from the records of the Vancouver General Hospital in a 3-year period, 34 proved to be examples of recurring subluxation. This high proportion of such patients contradicts the teaching in standard orthopaedic textbooks, but substantiates the warning of Rowe (1963) to beware of the patient whose shoulder 'dislocates' initially with little evidence of injury. It also substantiates Saha's concept (1971) of inherent shoulder instability as a contributor to the incidence of recurring dislocation.
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001265:Athletic Injuries / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery