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Multidirectional Shoulder Instability

Lennard Funk & Kathleen Roney, 2008


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Definition (Neer)
 = Abnormal amount of excursion of the humeral head on the glenoid in all directions 

Classification - Neer
Group I   Antero-inferior dislocation / Posterior subluxation
Group II   Postero-inferior dislocation /Anterior subluxation
Group III   Global dislocation

Definitions

  • Instability = a symptom, usually one direction
  • Laxity = a sign, usually multidirectional
  • Multidirectional Instability - VERY Rare

Stanmore Classification (Bayley Triangle)

Examination

  • Laxity - using Cofield's technique
  • Gagey Test for Inferior capsule
  • Muscle Patterning
  • Kinetic Chain
  • Generalised Hypermobility (Beighton Score)

Investigations

In all cases: X-Ray (AP and axillary views), MR Arthrogram

If indicated: CT scan, EMG's, EUA & Arthroscopy

Decision Making

  • Polar Type I = Surgery (+ rehab)Management
  • Polar Type III = Specialist Shoulder Physiotherapy
  • Polare Type II = combination of above (needs skillful and careful management)

Shoulder Therapy
Concentrates on:

  1. Core stability
  2. Scapula Stability
  3. Muscle patterning
  4. Proprioception
  5. Functional Rehab.

Combined Rehab exercises incorporate Core stabilty, Proprioception, Scapula, ROM, Strength
See more here

Surgery
Treat ALL Pathology present:

  • Labral (Anterior, Posterior, Superior)
  • Capsule Laxity
  • HAGL
  • Bone Defects (Humeral Head, Glenoid)
  • Cuff tears

 


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