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Selected Instructional Course Lecture   |    
Principles for the Evaluation and Management of Shoulder Instability
Frederick A. MatsenIII, MD1; Caroline Chebli, MD1; Steven Lippitt, MD2
1 Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 N.E. Pacific Street, Box 356500, Seattle, WA 98195. E-mail address for F.A. Matsen III: matsen@u.washington.edu
2 Akron General Medical Center, 224 West Exchange Street, Suite 440, Akron, OH 44302
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated (DePuy endowed chair.)
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2007 in Instructional Course Lectures, Volume 56. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(3):647-659
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Extract

During use of the normal shoulder, the humeral head is centered within the glenoid and the coracoacromial arch. When the shoulder cannot maintain this centered position during use, it is unstable. An unstable shoulder prevents normal function of the upper extremity. Shoulder instability is not the same as joint laxity. Joint laxity is a property of normal joints and allows the shoulder to attain its full range of functional positions.The concavity of the glenoid and the coracoacromial arch along with the passive and active forces that press the humeral head into the glenoid and the coracoacromial arch maintain the head in its centered position. This concavity-compression mechanism is dependent on the integrity of the glenoid and the coracoacromial arch, muscular compression, and restraining ligaments of the shoulder. Loss of any of these elements due to developmental, degenerative, traumatic, or iatrogenic factors may compromise the ability of the shoulder to center the humeral head in the glenoid.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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