Differential Diagnosis of Shoulder Instability

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Differential Diagnosis of Shoulder Instability

• Charlie Cotterill
• Junior Physiotherapist
• March 2006

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• Inappropriate activation of torque producing
  muscles
• Destabilising shear force across the joint.

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Differential Diagnosis?

• Labrum tear Bankart, Kim, SLAP lesion
• Avulsion of glenohumeral ligament (superior,
  middle, inferior), Posterior glenoid spur (a
  Bennett lesion), Cervical/Thoracic spine,
  Glenohumeral arthritis, Long thoracic nerve
  injury, Tumor/Malignancy, Post CVA, Humeral
  subluxation/dislocation
• Ganglion cyst, Suprascapular nerve entrapment,
  Quadrilateral space syndrome, Scapulothoracic
  dysfunction, Impingement of R/C, R/C tear,
  glenoid erosion, glenoid retroversion, humeral
  head defects, capsular insufficiency, voluntary
  instability, ?hypermobility

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Rehab

• Education
• Movement pattern correction
• Kinetic chain
• Proprioception/neuromuscular control
• Scapula stability
• Glenohumeral translatory control

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Evidence
Through seeking we may learn and know things
better. But as for certain truth, no man hath
known it, for all is but a woven web of
guesses. Xenophanes, 6th Century BC
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REFERENCES

• Robinson M and Aderinto J (2005) Recurrent
  Posterior Shoulder Instability, Journal of Bone
  Joint Surg Am.
• 87883-892.
• Matsen FA 3rd, Titelman RM, Lippitt SB, Rockwood
  CA Jr, Wirth MA. (2004) Glenohumeral
  instability. In Rockwood CA Jr, Matsen FA 3rd,
  Wirth MA, Lippitt SB, editors. The shoulder.
  Volume 2. 3rd ed. Philadelphia Saunders. p
  655-794.
• Falla D, Hess S and Richardson C (2003)
  Glenohumeral Joint Instability Strength In
  Baseball Players With Physical Signs Of
  Evaluation Of Shoulder Internal Rotator Muscle,
  Br. J. Sports Med.37430-432
• Malone A, Jaggi A et al (2004) Muscle Patterning
  Instability Classification and Prevalence in a
  Tertiary Referral Shoulder Service. Proceedings
  of the International Congress of Shoulder
  Surgery. Washington DC.
• Lephart et al (1994) Proprioception of the
  shoulder joint in healthy, unstable and
  surgically repaired shoulders. Journal of
  Shoulder and Elbow Surgery, 3 (6), 371-380
• Kibler B, Maddux J, Brooks P, Zeller B, McMullen
  J (2002). A Qualitative clinical evaluation of
  scapular dysfunction A reliability study.
  Journal of Shoulder Elbow Surgery.
  11(6)550-556,
• Kibler B, and McMullen J ( 2003) Scapular
  Dyskinesis and Its Relation to Shoulder Pain, J
  Am Acad Orthop Surg, Vol 11, No 2,, 142-151.
• Kibler B (1998) The role of the Scapula in
  Athletic shoulder function. The American Journal
  of Sports Medicine, 26 (2), 325-337
• Emery and Mullji (1991) Glenohumeral joint
  instability in normal adolescents, Journal of
  Bone Joint Surg, 73 (3) 406-408
• Naughton et al (2005) Upper-body wobbleboard
  training effects on the post-dislocation
  shoulder, Physical Therapy in Sport, 6, 31-34

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REFERENCES

• Takwale, Calvert, and Rattue (2000) Involuntary
  positional instability of the shoulder in
  adolescents and young adults IS THERE ANY
  BENEFIT FROM TREATMENT? J Bone Joint Surg Br,
  82-B 719 - 723.
• PA Dowdy and SW O'Driscoll (1993) Shoulder
  instability. An analysis of family history, J
  Bone Joint Surg Br, Sep 1993 75-B 782 - 784.
• Gerber and Ganz (1984) Clinical assessment of
  instability of the shoulder. With special
  reference to anterior and posterior drawer tests,
  J Bone Joint Surg Br, Aug 1984 66-B 551 - 556.