Dynamic examination techniques in shoulder instability

We prospectively examined 25 patients with recurrent shoulder dislocation before surgical stabilization. On the basis of preoperative and intraoperative findings, a preliminary working diagnosis was established; anterior dislocation in 14 patients, posterior dislocation in 4, and unclassified dislocation in 7. Glenohumeral joint laxity was subsequently assessed by clinical examination, fluoroscopy, and ultrasonography in all patients and in a control group of 25 subjects without shoulder disease. Normal laxity was defined as humeral head displacement not exceeding the standard deviation of the mean in the control group. Ultrasonographic findings were poorly reproducible and concurred with the results of clinical examination in only 4 patients and with fluoroscopic results in 7 patients. Clinical examination and fluoroscopic findings were reproducible and were identical in 19 patients. Laxity was present in 23 shoulders at clinical examination and in 18 shoulders at fluoroscopic examination. The preliminary working diagnosis was confirmed in 10 patients by clinical examination and in 6 patients by fluoroscopy. Previously unknown laxity was revealed by clinical examination in 13 and by fluoroscopy in 11 shoulders. Glenohumerol joint laxity should be evaluated before the operation by clinical and fluoroscopic examinations and must be taken into account in the operative techniques used to achieve stability.