Clinical examination of the unstable shoulder.
The clinical history is usually a very helpful guide for identifying frank traumatic glenohumeral joint dislocations. Glenohumeral dislocation most commonly occurs in the anterior direction (>95%) with the shoulder forcibly abducted and externally rotated. Atraumatic, multidirectional and subtler glenohumeral instability are often harder to diagnose. The presence of a sulcus of two or more centimetres beneath the acromion while pulling the arm inferiorly is predictive of multidirectional instability [likelihood ratio (LR) 9]. The O'Brien's sign is helpful for diagnosing superior labral detachment (LR 3 to 50). Load and shift tests, when positive, are extremely predictive for instability (LR >80), but when absent are poor at ruling out posterior and inferior instability. The apprehension sign and its variations (augmentation, relocation and release) have reasonable inter-examiner reliability (intraclass correlation coefficient 0.5 to 0.7) and are highly predictive for anterior instability (LR 8 to 100).
Tzannes
Anthony
A
Sports Medicine and Shoulder Service, Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
Murrell
George A C
GA
D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology; D008349:Manipulation, Orthopedic / Q000379:methods; D010808:Physical Examination / Q000379:methods; D012783:Shoulder Dislocation / Q000175:diagnosis* / Q000503:physiopathology