CLASSIFICATION AND PHYSICAL DIAGNOSIS OF INSTABILITY OF THE SHOULDER

Recent clinical and basic science work has increased our knowledge of shoulder instability. Valuable information has been pined by cutting s tudies of the capsuloligamentous complex to clarify the biomechanics o f instability. It is now clear that a significant overlap exists in th e concepts of instability and impingement relating to anterior shoulde r pain. These concepts have added new importance to organization and s tandardization when classifying and diagnosing shoulder instability. T his manuscript presents an algorithmic approach to classification of s houlder girdle complaints that may be related to instability. This cla ssification system is designed around the direction, degree, chronolog y, cause, and volition of instability. With accurate and detailed anal ysis of the historical presentation, most shoulder instability complai nts can be classified using this approach. The physical examination al so should proceed in an orderly fashion, including general impression of the musculoskeletal system, inspection, palpation, and range of mot ion of both the uninvolved and involved shoulder, neurologic examinati on, rotator cuff evaluation, and stability assessment. Stability asses sment includes glenohumeral translation examination with apprehension and provocative testing. Management techniques are predicted on an acc urate diagnosis. With a thorough and organized examination, the correc t diagnosis can be achieved.