Clinical and radiological examination of bony-mediated shoulder instability

Overview

This review in EFORT Open Reviews (Stefaniak et al., 2020) describes how to assess bone defects of the glenoid and humeral head in patients with anterior shoulder instability. Identifying and measuring these defects is important for pre-operative decision-making, because bone loss on one or both sides increases the risk that instability recurs after soft-tissue repair.

Medical history

The authors list factors associated with a higher risk of recurrence, including male sex, younger age at first dislocation, a growing number of dislocations, contact sports, manual work and epilepsy.

Physical examination

Findings such as a positive bony apprehension test, catching, and crepitus during shoulder movement may suggest an underlying bony deficiency.

Imaging

Plain radiographs in anteroposterior and axial views can reveal specific bony lesions in recurrent anterior instability. Computed tomography with multiplanar reconstruction and three-dimensional rendering allows not only detection but also quantification of glenoid and humeral defects and assessment of how they interact as a bipolar lesion, including whether a Hill–Sachs lesion is engaging and whether it lies on or off the glenoid track. MRI is developing quickly and can offer comparably accurate bone assessment without radiation exposure.

Clinical relevance

Combining history, examination and appropriate imaging helps surgeons judge whether soft-tissue repair alone is likely to be sufficient or whether bone-directed procedures should be considered.

Why it matters

Anterior shoulder dislocation is common, particularly in young and active people, and recurrence can limit sport, work and daily life. Recognising significant bone loss before surgery helps avoid repeated operations and supports choosing the procedure most likely to restore lasting stability.

Who it is for

Orthopaedic and shoulder surgeons, sports medicine physicians and musculoskeletal radiologists.