|
Year |
2002 |
|---|---|
|
Question Number |
247 |
|
Category |
Shoulder and Elbow |
Question
A 16 year old female swimmer has had right shoulder pain for the past 6 months. Ultrasound treatment and rest have failed to provide relief. Examination reveals bilateral 2+ glenohumeral translation, hyperextensible elbows, and a positive impingement sign. Management should now consist of
1) corticosteroid injection
2) scapular muscle and rotator cuff strengthening
3) arthroscopic capsular shift
4) arthroscopic thermal capsulorrhaphy
5) arthroscopic acromioplasty
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Answer (click for answer)
Preferred Response: 2
There are several clues in the history that are intended to lead you to the diagnosis of multi-directional instability. Chief among them are the bilateral, non-traumatic, nature of the shoulder complaint, in addition, the patient has multiple other lax joints, and complains of pain, not ‘instability’ per se. As we have discussed in conference with Dr. Lazarus, and as cited in the above article, the first line treatment for shoulder laxity in 6 months of aggressive shoulder excersise/strengthening therapy. If this fails to provide relief and the patient is not willing or able to stop the offending activity then an open inferior capsular shift is an option.
Reference: Burkhead WZ Jr, et al: Treatment of instability of the shoulder with an exercise program. J Bone and Joint Surg 1992; 74:890-896