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Clinical Examination of the Unstable Shoulder

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Abstract

The clinical history is usually a very helpful guide for identifying frank traumatic glenohumeral joint dislocations. Glenohumeral dislocation most commonly occurs in the anterior direction (>95%)with the shoulder forcibly abducted and externally rotated. A traumatic, multidirectional and subtler glenohumeral instability are often harder to diagnose. The presence of a sulcus of two or more centimetres beneath the acromion while pulling the arm inferiorly is predictive of multidirectional instability [likelihood ratio (LR) 9]. The O’Brien’s sign is helpful for diagnosing superior labral detachment (LR 3 to 50). Load and shift tests, when positive, are extremely predictive for instability (LR >80), but when absent are poor at ruling out posterior and inferior instability. The apprehension sign and its variations (augmentation, relocation and release) have reasonable inter-examiner reliability (intraclass correlation coefficient 0.5 to 0.7) and are highly predictive for anterior instability (LR 8 to 100).

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Acknowledgements

Supported by the St George Hospital/South East Sydney Area Health Service. The authors have no conflicts of interest.

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  1. University of New South Wales, Sydney, New South Wales, Australia

    Anthony Tzannes & George A. C. Murrell

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Correspondence to George A. C. Murrell.

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Tzannes, A., Murrell, G.A.C. Clinical Examination of the Unstable Shoulder. Sports Med 32, 447–457 (2002). https://doi.org/10.2165/00007256-200232070-00004

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