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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Shoulder Instability
Jolanda J. Luime, Arianne P. Verhagen, Harald S. Miedema, Judith I. Kuiper, Alex Burdorf, Jan A. N. Verhaar, Bart W. Koes
Figure 44-3. Clinical Tests to Evaluate Anterior Instability of the Shoulder

Topics Discussed: criterion standard comparisons (diagnostic tests), shoulder dislocations, shoulder instability

Excerpt: "The diagnosis of an acute shoulder dislocation is easy to establish. It is a painful condition and the patient will hold the arm in a fixed position (Figure 44-2).1,10-12 However, patients with shoulder instability without dislocation present in a more subtle way. Some patients may complain about a "dead arm" feeling.1,10 Symptoms of pain and functional disability seem to be nonspecific for the presence of instability.1,19 Instability of the shoulder should be considered when patients have shoulder discomfort without clear restriction of motion. A history of dislocation increases the likelihood of recurrent instability. Instability occurs more commonly in young people, although traumatic dislocation also occurs in older patients.1,13..."
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