Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, symptomatic right shoulder instability characterized by generalized laxity and recurrent subluxation episodes in multiple planes (anterior, posterior, and inferior). Reports vague shoulder pain, clicking, and a sensation of the humeral head "shifting" during overhead activities or reaching behind the back. No history of acute traumatic dislocation; symptoms are insidious in onset and exacerbated by repetitive loading.
Clinical Examination Findings
Right shoulder examination reveals positive Sulcus sign (grade 2+) indicating inferior laxity. Anterior and posterior drawer tests demonstrate increased humeral head translation compared to the contralateral side. Generalized ligamentous laxity noted (Beighton score: [X]/9). Rotator cuff strength is 5/5, though scapular dyskinesis is observed during active range of motion. Neurovascular status is intact distally.
Treatment Protocol
Initiate conservative management with a structured physical therapy program focusing on rotator cuff strengthening, scapular stabilization, and proprioceptive neuromuscular facilitation. Avoidance of provocative overhead activities. Consider NSAIDs for symptomatic relief. If symptoms persist despite 6 months of dedicated rehabilitation, surgical consultation for capsular shift or thermal capsulorrhaphy may be indicated.