Summary
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 that subluxation of the shoulder upon physical examination does not necessarily mean that 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.
Similar content being viewed by others
References
Matsen F, Lippitt S, Sidles J, et al. Stability. In: Practical evaluation and management of the shoulder. Philadelphia: Saunders, 1994: 59–109
McFarland E, Shaffer B, Glousman R, et al. The clinical diagnosis and diagnostic evaluation of anterior instability, impingement and rotator cuff tears. In: Jobe F, editor. Operative techniques in upper extremity sports injuries. St. Louis: Mosby, 1996: 177–90
McFarland E, Campbell G, McDowell J. Posterior shoulder laxity in asymptomatic adolescent athletes. Am J Sports Med 1991; 24: 460–71
Saha AK. Dynamic stability of the glenohumeral joint. Acta Orthop Scand 1971; 42: 479–93
Morrey BF, An K-N. Biomechanics of the shoulder. In: Rockwood C, Matsen F, editors. The shoulder. Philadelphia: Saunders, 1990
Pagnani M, Warren R. Stabilizers of the glenohumeral joint. J Shoulder Elbow Surg 1994; 173-90
O’Brien S, Neves M, Arnowsky S, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990; 18: 449–56
Moseley HE, Overguard B. The anterior capsular mechanism in recurrent anterior dislocation of the shoulder. J Bone Joint Surg 1962; 19: 913–27
Rodosky MW, Homer CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med 1994; 22: 121–30
Ferrari D. Capsular ligaments of the shoulder. Am J Sports Med 1990; 18: 20–4
Harryman D, Sidles JA, Clark S, et al. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg 1990; 72A: 1334–42
Warren R, Kornblatt IB, Marchand R. Static factors affecting posterior shoulder stability [abstract]. Orthop Trans 1984; 8: 89
Warner J, Deng X, Warren R, et al. Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 1992; 20: 675–85
Bowen M, Warren R. Ligamentous control of shoulder stability based on selective cutting and static translation experiments. Clin Sports Med 1991; 10: 757–82
O’Brien SJ, Schwartz RS, Warren RF, et al. Capsular restraints to anterior-posterior motion of the abducted shoulder: a bio-mechanical study. J Shoulder Elbow Surg 1995; 4: 298–308
Harryman D, Sidles J, Harris S, et al. The rotator cuff interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am 1992; 74-A: 53–66
Oveson J, Nielsen S. Experimental distal subluxation in the glenohumeral joint. Arch Orthop Trauma Surg 1985; 104: 78–81
Hsu H-C, Luo Z-P, Cofield RH, et al. Influence of rotator cuff tear on glenohumeral stability: the effect of size and location on the tear from a ‘created defect’ model. Eleventh Open Meeting, American Shoulder and Elbow Surgeons; 1996 Feb 25; Orlando
Gibb TD, Sidles JA, Harryman DT, et al. The effect of capsular venting on glenohumeral laxity. Clin Orthop 1991; 268: 120–7
Moorman C, Deng X-H, Warren RF, et al. The coracoacromial ligament: is it the appendix of the shoulder [abstract]? Eleventh Open Meeting, American Shoulder and Elbow Surgeons; 1996 Feb 25; Orlando
Warner JP, McMahon PJ. The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg 1995; 77A: 366–72
Harryman D, Sidles J, Harris S, et al. Laxity of the normal glenohumeral joint: a quantitative in vivo assessment. J Shoulder Elbow Surg 1992; 1: 66–76
Gerber C, Krushell RJ. Isolated ruptures of the subscapularis muscle. J Bone Joint Surg 1991; 73B: 389–94
Silliman J, Hawkins R. Classification and physical diagnosis of instability of the shoulder. Clin Orthop Relat Res 1993; 291: 7–19
Hawkins R, Bokor D. Clinical evaluation of shoulder problems. In: Rockwood C, Matsen F, editors. The shoulder. Philadelphia: Saunders, 1990: 149–77
Gerber C, Ganz R. Clinical assessment of instability of the shoulder. J Bone Joint Surg Br 1984; 66-B: 551–6
Mallon W, Speer K. Multidirectional instability: current concepts. J Shoulder Elbow Surg 1995; 4: 55–64
Cofield R, Nessler J, Reinhard W. Diagnosis of shoulder instability by examination under anaesthesia. Clin Orthop Relat Res 1993: 191: 45–53
Emery R, Mullaji A. Glenohumeral joint instability in normal adolescents. J Bone Joint Surg Br 1991; 73-B: 406–8
Lintner S, Speer K, Levy A, et al. The spectrum of glenohumeral translation in the asymptomatic athlete’s shoulder [abstract]. J South Orthop Assoc 1995; 4: 148
Zemek MJ, MaGee DJ. Comparison of glenohumeral joint laxity in elite and recreational swimmers. Clin J Sports Med 1995; 6: 40–7
Ansell B. Hypermobility in joints. In: Apley G, editor. Modern trends in orthopaedics-6. London: Butterworths, 1980: 25–39
Tsutsui H, Yamamoto R, Yoshikatsu K, et al. Biochemical study on collagen from the loose shoulder joint capsules. In: Post M, editor. Surgery of the shoulder. St. Louis: Mosby, 1990: 108–11
Pollock R, Bigliani L. Glenohumeral instability: evaluation and treatment. J Am Acad Orthop Surg 1993; 1: 24–32
Cooper R, Brems J. The inferior capsular-shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am 1992; 74-A: 1516–21
Kvitne R, Jobe F. The diagnosis and treatment of anterior instability in the throwing athlete. Clin Orthop 1993; 291: 107–23
Fronek J, Warren R, Bowen M. Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am 1989; 71-A: 205–16
Rowe C, Pierce D, Clarck J. Voluntary dislocation of the shoulder. J Bone Joint Surg Am 1973; 55-A: 445–60
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McFarland, E.G., Torpey, B.M. & Curl, L.A. Evaluation of Shoulder Laxity. Sports Med. 22, 264–272 (1996). https://doi.org/10.2165/00007256-199622040-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199622040-00005