Download Surgery of Shoulder Instability by Patrick N. Siparsky, Dean C. Taylor (auth.), Stephen F. PDF

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Range of motion (ROM) examination can help ensure glenohumeral reduction. A complete neurovascular exam including strength testing of the deltoid and external rotators can assess axillary and suprascapular nerve function. In patients that have had prior open surgery, it’s important to test subscapularis function as failure of prior repair can occur [7]. The mainstay of the physical exam for patients with suspected shoulder instability involves special tests aimed at characterizing the shoulder instability pattern.

2 Diagnosis The diagnosis of recurrent traumatic anterior glenohumeral instability is usually made easily on the basis of the history of distinct dislocation or subluxation and the positive apprehension sign. The anterior apprehension test is done with the patient in the supine position. In this test, the shoulder is moved passively into maximum external rotation with the arm at side, 30, 60, 90, 120, 150° of abduction, and maximum flexion [17, 18]. At the same time, the posterior apprehension test is done with the arm at maximum internal rotation in 90° of abduction.

Bracing for return-to-sport for shoulder instability has not been shown to decrease recurrence rate, although can be associated with subjective improvement in stability [2]. Bracing can range from motion-limiting braces that limit abduction, extension, and external rotation to neoprene sleeves. Collision athletes tend to tolerate the motion-limiting braces better than overhead athletes, and these may help provide an increased sense of stability and assist with return to play. 2 Risks Associated with Nonoperative Treatment Nonoperative management for shoulder instability in collision athletes is associated with a high recurrence rate, as outlined above, and is well documented in the literature.