Evaluation of Shoulder Laxity

Abstract

An understanding of the anatomy and biomechanical features of the glenohumeral joint is necessary when understanding the concept of shoulder laxity. Glenohumeral laxity is a normal feature of shoulder motion, but only when that laxity becomes excessive does instability occur. The clinician must use the history and physical examination to distinguish normal from pathological laxity. Several examination techniques are commonly used to evaluate anterior, posterior, inferior, and multidirectional shoulder laxity. It has become appreciated the subluxation of the shoulder is clinically or symptomatically unstable. This paper reviews the current techniques to evaluate shoulder laxity and discusses the interpretation of these examinations as they relate to normal and pathological laxities.

Anterior instability of the shoulder after trauma

“…Physical examination should include screening for evidence of generalised ligamentous laxity 64,65 and performing provocative tests to define the direction and extent of instability.…”

Does This Patient Have an Instability of the Shoulder or a Labrum Lesion?

“…Grade 0 denotes little to no movement; grade 1 denotes the humeral head moves onto the glenoid rim; grade 2 indicates the humeral head can be dislocated, but spontaneously relocates; and grade 3 indicates the humeral head does not relocate when the pressure is removed. 1,20 In the Hawkins scheme, grades 1 to 3 are seen as positive outcomes on a laxity test.…”

Calcific tendinitis of the rotator cuff as a cause of drooping shoulder

“…Further, it was also reported both in patients presenting with rotator cuff tears and in patients after rotator cuff repair or prosthetic replacement of the humeral head [5,6]. Finally, inferior glenohumeral subluxation is a well-known condition in generalized joint laxity and in multidirectional instability of the shoulder [7,8]. Here we describe a patient who presented with a drooping shoulder secondary to acute calcific tendinitis of the rotator cuff, which was corrected by aspiration of the calcific mass.…”

“…Muscle hypotonicity, probably due to a reflex reaction to pain, has been suggested as the major cause of inferior glenohumeral subluxation occurring in a few cases of rotator cuff tearing [5] and after shoulder surgery [6]. Finally, other etiologic factors have to be considered in the pathogenesis of inferior subluxation occurring in multidirectional instability, namely various capsuloligamentous lesions secondary to significant trauma or to repetitive minor injury, combined with varying degrees of inherent ligamentous laxity [7,8].…”