Shoulder Instability – Part II, Assessment Of Shoulder Instability

[physiobob]

KEY FACTORS OF ASSESSMENT

So how do we identify patients? We have already described the younger patient who starts off subluxing or dislocating the shoulder joint as a ‘party-trick’ but over time finds that this pattern becomes established and involuntary. According to Malone (3) in the Polar type III group approximately half will present with pain and a third with recurrent involuntary dislocation associated with everyday use.

Patients are often unaware that they are subluxing with movement and think this is ‘normal’. Patients rarely report any significant trauma – often they describe an innocuous knock in the playground or catching their arm on a door jam. Often the shoulder relocates spontaneously after the original event. In those patients who suffer a first dislocation with minor trauma and attend casualty due to an inability to relocate the joint, there are clues which make you suspect muscle patterning.

Often the joint will be very difficult to relocate and may require surgical reduction with anaesthetic. The patient may report that the joint then redislocated quickly after reduction. It is essential to elicit an accurate description of the precipitating event in these patients.

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