SHOULDER INSTABILITY IN

ATHLETES
OUTLINE

• Introduction
• Anatomy and Pathoanatomy
• Clinical assessment
• Radiological assessment
• Management
• Prognosis
• Conclusion
ANATOMY

• Articulation between Glenoid and humeral head

• Good ROM at the expense of stability
• “Golf ball on the tee”
• Only ¼ of the humeral head is in contact
• Stabilizers – Static/ Dynamic
• Static (Passive)
- Congruency
- Labrum
- Glenohumeral ligaments
- Negative pressure
• Dynamic (Active)
- Rotator cuff muscles
 ANATOMY
• Labrum
fibro cartilagenous rim attached to glenoid
increases the contact area for humeral head
Visco-elastic piston effect
attachment site for capsule, ligaments & tendon
(Orthopaedics & Traumatology: Surgery & Research 101 (2015) S19–S24)

• Glenohumeral ligaments
Critical for stability ; attached between labrum and humerus
SGHL, MGHL, IGHL
IGHL – most important stabilizer in 90 abduction and external rotation
( Curr reviw in Muscskelt Medicine (2011) 4:200-207)

• Rotator cuff
 PATHOANATOMY
• ROM STABILITY
• Prone to dislocation in 90 abduction and external rotation
• Dislocation detaches the antero inferior labrum from glenoid (Bankart lesion) –
“Essential lesion”
• Antero inferior glenoid rim fracture – Bony Bankart
• Bankart + Bony Bankart – 80 – 90%
• Humeral head compression – Hill-Sach’s lesion
• Other uncommon (but important) pathilogies (10 – 20%):
Avulsion of glenohumeral ligaments (HAGL)
Reverse HAGL
Bony HAGL
CLINICAL ASSESSMENT - HISTORY

• General details
• Mechanism of injury (contact/ non contact) and force of impact (major/ minor)
• Previous episodes
• Reduction
• Sleep dislocations
• Voluntary dislocation
• Dislocation with fits
• Features of hyperlaxity
• Limb neurological deficit
• Future ambitions in sports/ employment

(Curr Rev Muskuloskelet Med (2017) 10:434-441)

CLINICAL ASSESSMENT - EXAMINATION
• SEE (ant/ post/ Lat)
compare with contralateral side
contour
upper limb position
muscle wasting

• FEEL
areas of tenderness
muscle strength / rotator cuff strength
sensation – axillary nerve
• MOVE
active and passive ROM

(Curr Rev Muskuloskelet Med (2017) 10:434-441)

CLINICAL ASSESSMENT – SPECIAL MANOEUVRES

• Apprehension test
upright/ supine – 90 abduction & 90 external rotation
• Apprehension relocation test
manual stabilization of the shoulder while apprehension test is progressing
• Bony apprehension test
• Anterior release test
• Anterior load test
• Generalized laxity – “Sulcus sign”