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Consideration of an unstable shoulder

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Signs of laxity:
The search for general signs of hypermobility is part of the review of the unstable shoulder hyper-extensibility at the metacarpophalangeal joint of the index or the third finger on the wrist and thumb metacarpo-phalangeal , hyper-extensibility at the elbow etc ...
The laxity testing at shoulder level imply a relaxation of the capsular ligament apparatus.
Anteroposterior drawer ( "drawer test")
This research on a seated patient, relaxed shoulder, elbow bent, forearm resting on the thigh. The examiner, placed behind the patient, surrounds the humeral head with one hand while the other hand stabilizes the shoulder acromioclavicular level, then prints the anterior humeral head translation movements and later enjoying the trip the head, the occurrence of apprehension reaction or not the child, hanging or cracking raising the possibility of damage to the bead.
Furrow Test ( "sulcus sign")
Always in the same examination position, the examiner pulls of downward force to the lower part of the arm; the appearance of a groove at the lower edge of the acromion more or less marked sign laxity below the shoulder level.
"Push-Pull Test"
This research on a patient lying, shoulder resting in a vacuum on the side of the examination table, arm in 90 ° of abduction in the scapular plane (30 ° flexion). The examiner pulls up at the wrist ( "pull") while the other hand holds the arm down ( "push"). It occurs on a subject released a posterior translation of the greater or lesser humeral head (up to 50% in normal subjects).
Signs of instability:
In this case, examination signs assume the power of the capsular ligament apparatus, capable of withstanding anteroposterior translation forces.
Apprehension test ( "Crank Test")
On a subject sitting, the examiner grabbing the wrist bears the arm abducted 90 ° or more, and external rotation with one hand, while on the other, the stabilizing shoulder acromioclavicular level, thumb exerts a forward translational force on the humeral head.
As part of the anterior instability, the patient experiences apprehension during this maneuver even opposed.
"Jerk Test"
Always in the same examination position, the examiner leads in one hand the arm in horizontal adduction and internal rotation using a rearward thrust, while the other hand stabilizes the scapula. In case of posterior shoulder instability, there may be a "jerk" when suddenly the humeral head out of the glenoid concavity of the back that is reduced when returning to the starting position.
"Fulcrum test" and "test relocation"
Lying on a subject, shoulder sitting outside the edge of the examination table, the examiner moves the arm in abduction external rotation with one hand while the other hand grasping the posterior surface of the upper end of the arm exerts a biasing force toward the front gradually as the arm is brought in abduction and external rotation. The patient feels apprehensive or oppose it ( "fulcrum test"), fear disappears when the drive force applied by the other hand is carried down ( "relocation test").

Doctor Serge HERMAN, Doctor Yoann BOHU, Doctor Nicolas LEFEVRE. - 10 février 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


Shoulder instability of sports

Doctor Yoann BOHU.

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