nach oben

Current Reviews in Musculoskeletal Medicine

Erschienen in:

17.10.2017 | Management of Anterior Shoulder Instability (X Li, section editor)

Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability

verfasst von: Vincent A. Lizzio, Fabien Meta, Mohsin Fidai, Eric C. Makhni

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

The goal of this paper is to provide an overview in evaluating the patient with suspected or known anteroinferior glenohumeral instability.

Recent findings

There is a high rate of recurrent subluxations or dislocations in young patients with history of anterior shoulder dislocation, and recurrent instability will increase likelihood of further damage to the glenohumeral joint. Proper identification and treatment of anterior shoulder instability can dramatically reduce the rate of recurrent dislocation and prevent subsequent complications. Overall, the anterior release or surprise test demonstrates the best sensitivity and specificity for clinically diagnosing anterior shoulder instability, although other tests also have favorable sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and inter-rater reliabilities.

Summary

Anterior shoulder instability is a relatively common injury in the young and athletic population. The combination of history and performing apprehension, relocation, release or surprise, anterior load, and anterior drawer exam maneuvers will optimize sensitivity and specificity for accurately diagnosing anterior shoulder instability in clinical practice.

Owens BD, Campbell SE, Cameron KL. Risk factors for anterior glenohumeral instability. Am J Sports Med. 2014;42(11):2591–6. https://doi.org/10.1177/0363546514551149.CrossRefPubMed

Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB. The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med. 2007;35(7):1168–73. https://doi.org/10.1177/0363546506295179.CrossRefPubMed

Wilk KE, Reinold MM, Andrews JR. The athlete’s shoulder. Philadelphia: Churchill Livingstone/Elsevier; 2009.

• Leroux T, Wasserstein D, Veillette C, Khoshbin A, Henry P, Chahal J, et al. Epidemiology of primary anterior shoulder dislocation requiring closed reduction in Ontario, Canada. Am J Sports Med. 2014;42(2):442–50. https://doi.org/10.1177/0363546513510391. Cohort study involving a large population that analyzes incidence and risk factors for primary anterior shoulder dislocations and recurrent dislocations. CrossRefPubMed

Farrar NG, Malal JJ, Fischer J, Waseem M. An overview of shoulder instability and its management. Open Orthop J. 2013;7:338–46. https://doi.org/10.2174/1874325001307010338.CrossRefPubMedPubMedCentral

Berbig R, Weishaupt D, Prim J, Shahin O. Primary anterior shoulder dislocation and rotator cuff tears. J Shoulder Elb Surg. 1999;8(3):220–5.CrossRef

Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the shoulder in young patients: a ten-year prospective study. J Bone Joint Surg Am. 1996;78(11):1677–84.CrossRefPubMed

Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl. 2009;91(1):2–7. https://doi.org/10.1308/003588409X359123.CrossRefPubMedPubMedCentral

Hovelius L, Saeboe M. Neer award 2008: arthropathy after primary anterior shoulder dislocation—223 shoulders prospectively followed up for twenty-five years. J Shoulder Elb Surg. 2009;18(3):339–47. https://doi.org/10.1016/j.jse.2008.11.004.CrossRef

10.

Davis DE, Abboud JA. Operative management options for traumatic anterior shoulder instability in patients younger than 30 years. Orthopedics. 2015;38(9):570–6. https://doi.org/10.3928/01477447-20150902-07.CrossRefPubMed

11.

Gil JA, DeFroda S, Owens BD. Current concepts in the diagnosis and management of traumatic, anterior glenohumeral subluxations. Orthop J Sports Med. 2017;5(3):2325967117694338. https://doi.org/10.1177/2325967117694338.CrossRefPubMedPubMedCentral

12.

Huber H, Gerber C. Voluntary subluxation of the shoulder in children: a long-term follow-up study of 36 shoulders. J Bone Joint Surg Br. 1994;76(1):118–22.PubMed

13.

Chalmers PN, Cvetanovich GL, Kupfer N, Wimmer MA, Verma NN, Cole BJ, et al. The champagne toast position isolates the supraspinatus better than the Jobe test: an electromyographic study of shoulder physical examination tests. J Shoulder Elb Surg. 2016;25(2):322–9. https://doi.org/10.1016/j.jse.2015.07.031.CrossRef

14.

• Gombera MM, Sekiya JK. Rotator cuff tear and glenohumeral instability: a systematic review. Clin Orthop Relat Res. 2014;472(8):2448–56. https://doi.org/10.1007/s11999-013-3290-2. Recent systematic review that analyzes the risk factors, evaluation, and treatment of associated rotator cuff tears following an event of glenohumeral instability. CrossRefPubMed

15.

Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr. 2011;158(1):119–23, 23 e1-4. https://doi.org/10.1016/j.jpeds.2010.07.021.CrossRefPubMed

16.

Gagey OJ, Gagey N. The hyperabduction test. J Bone Joint Surg Br. 2001;83(1):69–74.CrossRefPubMed

17.

Bushnell BD, Creighton RA, Herring MM. The bony apprehension test for instability of the shoulder: a prospective pilot analysis. Arthroscopy. 2008;24(9):974–82. https://doi.org/10.1016/j.arthro.2008.07.019.CrossRefPubMed

18.

Gross ML, Distefano MC. Anterior release test. A new test for occult shoulder instability. Clin Orthop Relat Res. 1997;339:105–8.CrossRef

19.

Reider B. The orthopaedic physical examination, vol xiii, p. 383. Philadelphia: Elsevier Saunders; 2005.

20.

Silliman JF, Hawkins RJ. Classification and physical diagnosis of instability of the shoulder. Clin Orthop Relat Res. 1993;291:7–19.

21.

Tzannes A, Murrell GA. Clinical examination of the unstable shoulder. Sports Med. 2002;32(7):447–57.CrossRefPubMed

22.

Gerber C, Ganz R. Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. J Bone Joint Surg Br. 1984;66(4):551–6.PubMed

23.

Lerat JL, Chotel F, Besse JL, Moyen B, Brunet GE. Dynamic anterior jerk of the shoulder. A new clinical test for shoulder instability. Preliminary study. Rev Chir Orthop Reparatrice Appar Mot. 1994;80(6):461–7.PubMed

24.

Speer KP, Hannafin JA, Altchek DW, Warren RF. An evaluation of the shoulder relocation test. Am J Sports Med. 1994;22(2):177–83. https://doi.org/10.1177/036354659402200205.CrossRefPubMed

25.

Luime JJ, Verhagen AP, Miedema HS, Kuiper JI, Burdorf A, Verhaar JA, et al. Does this patient have an instability of the shoulder or a labrum lesion? JAMA. 2004;292(16):1989–99. https://doi.org/10.1001/jama.292.16.1989.CrossRefPubMed

26.

Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42(2):80–92; discussion. https://doi.org/10.1136/bjsm.2007.038406.CrossRefPubMed

27.

Tzannes A, Paxinos A, Callanan M, Murrell GA. An assessment of the interexaminer reliability of tests for shoulder instability. J Shoulder Elb Surg. 2004;13(1):18–23. https://doi.org/10.1016/S1058274603002453.CrossRef

28.

Farber AJ, Castillo R, Clough M, Bahk M, McFarland EG. Clinical assessment of three common tests for traumatic anterior shoulder instability. J Bone Joint Surg Am. 2006;88(7):1467–74. https://doi.org/10.2106/JBJS.E.00594.PubMed

29.

Taylor SA, Newman AM, Dawson C, Gallagher KA, Bowers A, Nguyen J, et al. The “3-pack” examination is critical for comprehensive evaluation of the biceps-labrum complex and the bicipital tunnel: a prospective study. Arthroscopy. 2017;33(1):28–38. https://doi.org/10.1016/j.arthro.2016.05.015.CrossRefPubMed

30.

Kim SH, Ha KI, Han KY. Biceps load test: a clinical test for superior labrum anterior and posterior lesions in shoulders with recurrent anterior dislocations. Am J Sports Med. 1999;27(3):300–3. https://doi.org/10.1177/03635465990270030501.CrossRefPubMed

31.

Kim SH, Ha KI, Ahn JH, Kim SH, Choi HJ. Biceps load test II: a clinical test for SLAP lesions of the shoulder. Arthroscopy. 2001;17(2):160–4. https://doi.org/10.1053/jars.2001.20665.CrossRefPubMed

32.

Sodha S, Srikumaran U, Choi K, Borade AU, McFarland EG. Clinical assessment of the dynamic labral shear test for superior labrum anterior and posterior lesions. Am J Sports Med. 2017;45(4):775–81. https://doi.org/10.1177/0363546517690349.CrossRefPubMed

33.

Kim SH, Park JC, Park JS, Oh I. Painful jerk test: a predictor of success in nonoperative treatment of posteroinferior instability of the shoulder. Am J Sports Med. 2004;32(8):1849–55.CrossRefPubMed

34.

Kim SH, Park JS, Jeong WK, Shin SK. The Kim test: a novel test for posteroinferior labral lesion of the shoulder—a comparison to the jerk test. Am J Sports Med. 2005;33(8):1188–92. https://doi.org/10.1177/0363546504272687.CrossRefPubMed

35.

van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Terwee CB, Willems WJ. Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability. J Shoulder Elb Surg. 2013;22(10):1310–9. https://doi.org/10.1016/j.jse.2013.05.006.CrossRef

36.

Lo IK, Nonweiler B, Woolfrey M, Litchfield R, Kirkley A. An evaluation of the apprehension, relocation, and surprise tests for anterior shoulder instability. Am J Sports Med. 2004;32(2):301–7. https://doi.org/10.1177/0095399703258690.CrossRefPubMed

37.

Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–78. https://doi.org/10.1136/bjsports-2012-091066.CrossRefPubMed

38.

Sciascia AD, Spigelman T, Kibler WB, Uhl TL. Frequency of use of clinical shoulder examination tests by experienced shoulder surgeons. J Athl Train. 2012;47(4):457–66. https://doi.org/10.4085/1062-6050-47.4.09.CrossRefPubMedPubMedCentral

39.

Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario shoulder instability index (WOSI). Am J Sports Med. 1998;26(6):764–72. https://doi.org/10.1177/03635465980260060501.CrossRefPubMed

40.

Skare O, Schroder CP, Mowinckel P, Reikeras O, Brox JI. Reliability, agreement and validity of the 1988 version of the Rowe score. J Shoulder Elb Surg. 2011;20(7):1041–9. https://doi.org/10.1016/j.jse.2011.04.024.CrossRef

41.

Dawson J, Fitzpatrick R, Carr A. The assessment of shoulder instability. The development and validation of a questionnaire. J Bone Joint Surg Br. 1999;81(3):420–6.CrossRefPubMed

42.

Anthony CA, Glass NA, Hancock K, Bollier M, Wolf BR, Hettrich CM. Performance of PROMIS instruments in patients with shoulder instability. Am J Sports Med. 2017;45(2):449–53. https://doi.org/10.1177/0363546516668304.CrossRefPubMed

Titel: Clinical Evaluation and Physical Exam Findings in Patients with Anterior Shoulder Instability
verfasst von: Vincent A. Lizzio
Fabien Meta
Mohsin Fidai
Eric C. Makhni
Publikationsdatum: 17.10.2017
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 4/2017
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-017-9434-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose of review

Recent findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2017

Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability

Degenerative Scoliosis

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

Treatment for Recurrent Lumbar Disc Herniation

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes