Differential Diagnosis of Shoulder Instability

1. Differential Diagnosis of Shoulder Instability Charlie Cotterill Junior Physiotherapist March 2006 Charlie Cotterill

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4. Inappropriate activation of torque producing muscles • Destabilising shear force across the joint. Charlie Cotterill

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8. Differential Diagnosis? Labrum tear; Bankart, Kim, SLAP lesion Avulsion of glenohumeral ligament (superior, middle, inferior), Posterior glenoid spur (a Bennett lesion), Cervical/Thoracic spine, # Glenohumeral arthritis, Long thoracic nerve injury, Tumor/Malignancy, Post CVA, Humeral subluxation/dislocation Ganglion cyst, Suprascapular nerve entrapment, Quadrilateral space syndrome, Scapulothoracic dysfunction, Impingement of R/C, R/C tear, glenoid erosion, glenoid retroversion, humeral head defects, capsular insufficiency, voluntary instability, ?hypermobility Charlie Cotterill

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10. Rehab • Education • Movement pattern correction • Kinetic chain • Proprioception/neuromuscular control • Scapula stability • Glenohumeral translatory control Charlie Cotterill

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14. Evidence “Through seeking we may learn and know things better. But as for certain truth, no man hath known it, for all is but a woven web of guesses.” Xenophanes, 6th Century BC Charlie Cotterill

15. REFERENCES Robinson M and Aderinto J (2005) Recurrent Posterior Shoulder Instability, Journal of Bone Joint Surg Am. 87:883-892. Matsen FA 3rd, Titelman RM, Lippitt SB, Rockwood CA Jr, Wirth MA. (2004) Glenohumeral instability. In: Rockwood CA Jr, Matsen FA 3rd, Wirth MA, Lippitt SB, editors. The shoulder. Volume 2. 3rd ed. Philadelphia: Saunders;. p 655-794. Falla D, Hess S and Richardson C (2003) Glenohumeral Joint Instability Strength In Baseball Players With Physical Signs Of Evaluation Of Shoulder Internal Rotator Muscle, Br. J. Sports Med.;37;430-432 Malone A, Jaggi A et al (2004) Muscle Patterning Instability – Classification and Prevalence in a Tertiary Referral Shoulder Service. Proceedings of the International Congress of Shoulder Surgery. Washington DC. Lephart et al (1994) Proprioception of the shoulder joint in healthy, unstable and surgically repaired shoulders. Journal of Shoulder and Elbow Surgery, 3 (6), 371-380 Kibler B, Maddux J, Brooks P, Zeller B, McMullen J (2002). A Qualitative clinical evaluation of scapular dysfunction: A reliability study. Journal of Shoulder & Elbow Surgery. 11(6):550-556, Kibler B, and McMullen J ( 2003) Scapular Dyskinesis and Its Relation to Shoulder Pain, J Am Acad Orthop Surg, Vol 11, No 2,, 142-151. Kibler B (1998) The role of the Scapula in Athletic shoulder function. The American Journal of Sports Medicine, 26 (2), 325-337 Emery and Mullji (1991) Glenohumeral joint instability in normal adolescents, Journal of Bone Joint Surg, 73 (3) 406-408 Naughton et al (2005) Upper-body wobbleboard training effects on the post-dislocation shoulder, Physical Therapy in Sport, 6, 31-34 Charlie Cotterill

16. REFERENCES Takwale, Calvert, and Rattue (2000) Involuntary positional instability of the shoulder in adolescents and young adults: IS THERE ANY BENEFIT FROM TREATMENT?J Bone Joint Surg Br, 82-B: 719 - 723. PA Dowdy and SW O'Driscoll (1993) Shoulder instability. An analysis of family history, J Bone Joint Surg Br, Sep 1993; 75-B: 782 - 784. Gerber and Ganz (1984) Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests, J Bone Joint Surg Br, Aug 1984; 66-B: 551 - 556. Charlie Cotterill