(iii) Examination under anaesthesia and arthroscopy for the unstable shoulder
✍ Scribed by S.A Copeland
- Publisher
- Elsevier Science
- Year
- 1996
- Tongue
- English
- Weight
- 977 KB
- Volume
- 10
- Category
- Article
- ISSN
- 0268-0890
No coin nor oath required. For personal study only.
✦ Synopsis
EXAMINATION UNDER ANAESTHESIA
Restoration of stability whilst maintaining mobility remains a diffficult clinical problem. Regaining stability may not be a great surgical triumph if it is associated with significant loss of mobility. The aim of most reconstructive surgery is to regain function and to repair anatomy. Nowhere is this more true than the shoulder. With the advent of arthroscopy this has given us an opportunity not available to our predecessors to assess intra-articular damage and hence institute appropriate surgical repair. Shoulder instability covers a very wide spectrum of problems. Any information that can be gained as to the anatomical damage is useful in planning treatment. In the majority of acute traumatic dislocations requiring reduction, diagnosis is not a problem. However, the more subtle degrees of instability presenting as pain or subluxation may be more difficult to diagnose and treat. Most information may be gained purely from a good clinical history and examination, but valuable extra information can be gained by examination under anaesthesia and arthroscopy. Examination under anaesthesia should be done before any stabilisation procedure.
It is often said that examination under anaesthesia is not useful as instability of the shoulder is a dynamic abnormality and 'all shoulders are unstable under anaesthetic'. This raises the difference between laxity and instability. Instability is defined as the symptomatic expression of excessive gleno-humeral