Shoulder instability

Question 1

What is meant by joint instability?

Answer 1

This is the increased risk and incidence of dislocation that occurs after an initial dislocation of a joint

Question 2

What is the most common cause of shoulder instability?

Answer 2

This is most common in teenage years to 30s, mostly occurring in traumatic incidences in sport

Question 3

What is the most common direction of shoulder dislocation leading to instability?

Answer 3

Anterior dislocation

Question 4

How will chronic shoulder instability present?

Answer 4

This will often present with atraumatic laxity, which will not be painful as joint receptors will have lost sensitivity

Question 5

What are some possible clinical signs of shoulder instability?

Answer 5

Abnormal shoulder contour
Muscle wasting
Tender on palpation
Muscle spasm
Scapular dyskinesia
Scapular winging
Preserved ROM

Question 6

What are some investigations used in shoulder instability?

Answer 6

X-ray (1st line)
MRI arthrogram

Question 7

How will joint instability be managed at acute presentation?

Answer 7

IV analgesia
O2
Sedative IV
Reduction by manipulation

Question 8

Describe the rehabilitation pathway of shoulder instability

Answer 8

• 6 week sling
• 8-10 weeks no driving
• 12 weeks no heavy lifting
• Return to sports:
  
  • 12 weeks non-contact
  • 6 months contact

Question 9

What are some injuries associated with shoulder instability?

Answer 9

• Labral lesions (Bankart tear)
• Fracture of the humoral head (Hill-Sachs)
• fracture of the glenoid (Bony Bankart)
• Rotator cuff tear

Question 10

How are Bankart lesions managed?

Answer 10

Arthroscopic or open stabilisation