SYNOPSIS: Anterior shoulder dislocation occurs in the general population; however, the incidence is doubled in the young athletic population. Over 90% of shoulder dislocations are in the anterior direction. For the first-time dislocation, a systematic approach to evaluating the patient and prompt reduction are critical. This injury is frequently witnessed on the field or later in the emergency department. On the field, closed reductions, without prereduction radiographs, is controversial. If the athlete is encountered in the emergency department, radiographs should be obtained prior to a closed reduction. After a closed reduction is achieved, several factors, such as timing in the season, type of sport, position, and patient goals, must be considered when deciding whether further surgical intervention is required. Conservative management will usually consist of a brief period of immobilization in a sling, followed by rehabilitation. Surgical treatment consists of an arthroscopic Bankart repair. LEVEL OF EVIDENCE: Therapy, level 5.

J Orthop Sports Phys Ther. 2009;39(2):118-123, Epub 11 August 2008. doi:10.2519/jospt.2009.2804

KEY WORDS: apprehension, Bankart, glenohumeral joint, instability, physical therapy

The dynamic muscle stabilizers of the shoulder are critical to high performance in the overhead athlete. Previous evaluations of shoulder strength have focused on the concentric strength of the rotator cuff. Functionally, the rotator cuff muscles interact in an eccentric/concentric fashion. This is the first study to evaluate the end range eccentric antagonist/concentric agonist ratios of the shoulder rotators. Seventy-five asymptomatic college-level males were tested through a range of 20° of lateral rotation to 90° of medial rotation using the Kin-Com computer-assisted, hydraulic-resisted, isokinetic dynamometer at a speed of 90°/sec. The end range (60-90°) ratios for the medial rotators functioning eccentrically and lateral rotators functioning concentrically were 2.39:1 and 2.15:1 for the dominant and nondominant shoulders, respectively. End range (10° of lateral rotation-20° of medial rotation) ratios for lateral rotators functioning eccentrically and medial rotators functioning concentrically were 1.08:1 and 1.05:1 for the dominant and nondominant shoulders, respectively. The application of this functional assessment of strength testing results may provide important information in the evaluation of the injured shoulder in the overhead athlete, for prescreening, and to gauge return to sports after injury or surgery.

J Orthop Sports Phys Ther. 1997;25(3):203-207.

Key Words: shoulder, muscle, dynamic strength