Glenohumeral Instability

Aka: Glenohumeral Instability, Shoulder Instability

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II. Pathophysiology

  1. Disorder of Shoulder capsule and Shoulder labrum

III. Epidemiology

  1. Age at onset typically under 40 years

IV. Risk Factors

  1. Collision Sport activity
  2. Shoulder overhead activity

V. Causes

  1. Glenohumeral Dislocation
  2. Glenohumeral Subluxation

VI. Symptoms

  1. Lateral deltoid numbness

VII. Signs

  1. Shoulder Apprehension Test positive

VIII. Imaging

  1. Shoulder XRay (low sensitivity, use to evaluate differential diagnosis)
    1. Hill-Sachs Lesion
    2. Shoulder Dislocation
    3. Inferior glenoid avulsion Fracture
  2. Shoulder MRI (preferred imaging of Shoulder labrum)

IX. Differential Diagnosis

  1. See Shoulder Pain
  2. SLAP Lesion (Superior labrum anterior to posterior)
    1. Results from avulsion of the long head of the bicipital tendon

X. Associated Conditions: Age over 40 years (related to dislocations or subluxations)

  1. Rotator Cuff Tears
  2. Glenohumeral Osteoarthritis

XI. Management

  1. Acute Management
    1. See Shoulder Subluxation
    2. See Shoulder Dislocation
  2. Follow-Up Management
    1. Reduce exacerbating factors
    2. Shoulder Strength Exercises
      1. Rotator Cuff strengthening Exercises
      2. Scapular stabilizer strengthening Exercises
    3. Indications for surgery (early orthopedic Consultation recommended)
      1. Course refractory to conservative measures
      2. Recurrent Shoulder Dislocation or Shoulder Subluxation

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