Instability of the Shoulder

Stability of the Shoulder

Factors that contribute to mobility:
• Type of joint – It is a ball and socket joint.
• Bony surfaces – Shallow glenoid cavity and large humeral head – there is a 1:4
disproportion in surfaces.
• Laxity of the joint capsule.

Factors that contribute to stability:

• Rotator cuff muscles – These muscles surround the shoulder joint, attaching to the
tubercles of the humerus, whilst also fusing with the joint capsule.
• Glenoid labrum- It deepens the cavity, reducing the risk of dislocation.
• Ligaments – The ligaments act to reinforce the joint capsule, and forms the coraco-
acromial arch.
 Terminology
Terms Definition
Joint Laxity • A lack of tautness & firmness
• A degree of translation in the glenohumeral joint which falls
within physiological range and which is asymptomatic

Joint Abnormal symptomatic motion for the shoulder which results in

Instability pain, subluxation or dislocation of the joint

Subluxation Symptomatic separation of the surfaces without dislocation

Dislocation Complete separation of the gleno-humeral surfaces
 Pathology Type 1 Type 2 Type 3

Trauma Yes No No
Articular Surface
Yes Yes No
Damage
Capsular Problem Bankart Lesion Dysfunctional Dysfunctional

Laxity Unilateral Uni/Bilateral Often Bilateral

Muscle Patterning Normal Normal Abnormal

Polar Type 1 – Traumatic Anterior
Instability
Pathology
• The most common type of instability (95%)
• Normally follows an acute injury caused by forced
• Abduction
• External rotation
• Extension
• Lesions associated
1. Bankart Lesion
2. Hill-Sachs Lesion
3. Both
BONY BANKART
LESION
Hill-Sachs lesion
 Clinical Features
HISTORY
• Young man or woman with history of his first dislocation
• Complained of recurrent subluxation
• ‘catching’ sensation
• During action with arm in a overhead position
• Subsequent dislocation when doing ordinary activities and can be reduced by patient
himself

PHYSICAL EXAMINATION
• Apprehension test +ve
• Anterior Drawer test +ve
• Sulcus Sign +ve
Investigations
• History and Physical Examination alone can diagnose
• X-ray
• AP with shoulder internally rotated
• Axillary view
• MRI or MR Arthrography
• Arthroscopy
• Examination under anaesthesia
Treatment
• Indications of surgery
1. Frequent dislocation (even at ordinary activities)
2. Painful
3. Fear of dislocation sufficient enough to prevent from participation
• Anatomical repair
• Repair the torn glenoid labrum and capsule
• Bankart procedure
• Reattachment and tightening of the torn labrum and ligaments of the
shoulder.
• This is usually done using sutures and small bone anchors.
Treatment
• Non-anatomical Repair
1. Putti-Platt operation
• Shorten anterior capsule and subscapularis by an overlapping repair
2. Bristow-Laterjet operation
• Reinforce the anterioinferior capsule by transposing coracoid process with its muscles
across the front of the joint