Work-up of glenohumeral instability

1. What are the symptoms of shoulder instability? How is laxity measured?
2. What are three tests for anterior GH instability?
3. What are two tests for posterior GH instability?
4. What is a test for multidirectional GH instability?
5. What imaging is done to assess GH instability? What special views are used for Bankart and Hill-Sachs lesions?

Answers:
1. Symptoms are early shoulder fatigue, pain, numbness, paresthesias. The shoulder slips out of place when in a "throwing" position. Joints are considered lax if the patient can touch the thumb against the flexor surface of the forearm.
2. The apprehension test (feeling of instability with 90 deg shoulder abduction and ext rotation), relocation test (relief of Apprehension with posterior directed force), anterior draw (passive anterior displacement).
3. The jerk test (arm in 90 flexion and int rot with elbow flexed 90 degrees --> patient jerks away when arm is passively adducted while pushing humerus posteriorly), posterior draw (posterior displacement of humerus).
4. The sulcus sign involves pulling down on the patient's arm while stabilizing scapula --> indentation between the acromion and the humeral head is a positive.
5. Routine AP, scapular Y view, axillary lateral view. The West Point lateral axillary is used for Bankart lesions and the Stryker notch view is used for Hill-Sachs.