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[Chronic instability and fixed dislocation of the shoulder].

R Fremerey1, U Bosch

  • 1Unfallchirurgische Klinik, Medizinische Hochschule Hannover.

Zentralblatt Fur Chirurgie
|April 17, 2001
PubMed
Summary

Chronic shoulder instability can be traumatic or atraumatic, affecting one or multiple directions. Treatment varies from surgery for traumatic cases to rehabilitation for multidirectional instability with hyperlaxity.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Biomechanics

Background:

  • Chronic shoulder instability encompasses traumatic and atraumatic origins, presenting with unidirectional or multidirectional patterns.
  • Differentiating symptomatic instability from asymptomatic hyperlaxity is crucial for appropriate management.
  • Posttraumatic, unidirectional anterior instability without hyperlaxity is the most prevalent form, characterized by apprehension and a negative sulcus sign.

Purpose of the Study:

  • To classify chronic shoulder instabilities based on etiology, directionality, and presence of hyperlaxity.
  • To delineate the distinct clinical presentations and diagnostic findings for each type of instability.
  • To outline the current treatment strategies, including surgical and conservative approaches, for various shoulder instability patterns.

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Main Methods:

  • Review of clinical presentations, diagnostic signs (apprehension test, sulcus sign), and patient history.
  • Categorization of instability into traumatic (anterior, unidirectional, with/without hyperlaxity), repetitive microtraumatic, multidirectional (with/without hyperlaxity), fixed posterior dislocation, and voluntary types.
  • Analysis of treatment outcomes, including surgical reconstruction (capsulolabral complex), conservative management (rehabilitation), and specific interventions like capsular shift or thermal shrinkage.

Main Results:

  • Posttraumatic anterior instability without hyperlaxity is common, while multidirectional instability with hyperlaxity responds to rehabilitation.
  • Repetitive microtraumatic instability in athletes requires conservative treatment.
  • Surgical intervention is indicated for traumatic instability, rare forms of multidirectional instability without hyperlaxity, and fixed posterior dislocations. Voluntary instability requires no specific therapy.

Conclusions:

  • Accurate diagnosis of shoulder instability type is essential for guiding effective treatment.
  • Surgical reconstruction remains the gold standard for specific traumatic instabilities.
  • Conservative management, particularly intensive rehabilitation, is effective for certain types of chronic shoulder instability, especially in athletes and those with hyperlaxity.