Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with recurrent episodes of left shoulder instability, describing a sensation of the humeral head "slipping" or "popping out" during overhead activities or abduction/external rotation. History significant for initial traumatic dislocation followed by multiple subluxation events. Reports associated apprehension, pain, and occasional paresthesia during instability episodes. No current neurological deficits or acute neurovascular compromise noted.
Clinical Examination Findings
Left shoulder examination reveals positive Apprehension test and Relocation test. Sulcus sign is negative. Load and shift test demonstrates increased anterior translation (Grade 2+). Range of motion is full but guarded in end-range abduction/external rotation. Rotator cuff strength is 5/5. Neurovascular status of the left upper extremity is intact with palpable distal pulses and normal capillary refill.
Treatment Protocol
Initiate physical therapy focusing on rotator cuff strengthening and scapular stabilization. Activity modification to avoid provocative overhead positions. Consider MRI arthrogram to evaluate for Bankart lesion or capsular laxity. If conservative management fails, discuss surgical stabilization (e.g., arthroscopic Bankart repair or Latarjet procedure) given the recurrent nature of the instability.