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Direction of Instability

The direction of instability has been a critical component of most classification systems. Traditionally, there was an assumption that 95% of shoulder instability was anterior. It has become increasingly apparent, however, that many athletes with ligamentous laxity have instability that is primarily posterior in nature.

These patients suffer recurrent posterior subluxation and have a history of posterior shoulder pain rather than complaints of frank instability. This category of patients is more prevalent than previously recognized but should be distinguished from the rare true posterior dislocation that results from an acute traumatic event.

Traumatic posterior shoulder dislocation is notoriously overlooked on initial patients presentation. Hawkins et al.It reported on a series of 40 patients with 41 locked posterior shoulder dislocations. The initial physician missed the diagnosis in the majority of the cases reviewed. In this often quoted series, the causes of posterior dislocation were motor-vehicle accidents, seizures, alcohol-related injuries, or electroshock therapy.

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