Dalton S E, Snyder S J
Baillieres Clin Rheumatol. 1989 Dec;3(3):511-34. doi: 10.1016/s0950-3579(89)80006-8.
Glenohumeral instability is an important cause of shoulder pain and disability in an active population. An awareness of the prevalence of recurrent instability, either in the form of dislocation or subluxation, is particularly useful in the assessment of the young athlete presenting with shoulder pain. Young adults presenting with rotator cuff tendinitis may have an underlying instability as the primary cause of their problem. A careful clinical examination should determine whether the instability is voluntary or involuntary, of traumatic or atraumatic onset, and the primary direction of the instability, as these factors have important implications with regard to treatment. Anterior glenohumeral instability is most common and the incidence of recurrent instability following on from an initial dislocation is high in the young active patient. An intensive rehabilitation programme is indicated for all initial dislocations or subluxations but surgery may become necessary after failure of conservative treatment. Care must be taken to determine accurately those patients with voluntary or multi-directional instability and a longer trial of conservative treatment is indicated here, as results of operative treatment in those cases are less favourable. Conservative treatment should be directed at strengthening the dynamic stabilizers of the shoulder joint, notably the rotator cuff muscles. Additional X-ray views are needed to demonstrate all the radiological changes associated with recurrent instability and further evaluation with examination under anaesthesia and arthroscopy is beneficial in the assessment of these patients. Arthroscopic surgery also has a role in the treatment of patients with symptomatic labral pathology and is now being used to perform stabilization procedures in selected cases. Many operative procedures have been described for stabilization of the shoulder and these should be directed at correcting the pathology present. Restoration of the patient's flexibility and strength postoperatively is essential, especially in the athlete in order to allow a full return to sporting activity.
肩肱关节不稳是活跃人群肩部疼痛和功能障碍的重要原因。认识复发性不稳（无论是脱位还是半脱位形式）的患病率，对于评估出现肩部疼痛的年轻运动员尤为有用。表现为肩袖肌腱炎的年轻人可能存在潜在的不稳，这是其问题的主要原因。仔细的临床检查应确定不稳是自愿性还是非自愿性的、创伤性还是非创伤性起病以及不稳的主要方向，因为这些因素对治疗具有重要意义。肩肱关节前不稳最为常见，年轻活跃患者初次脱位后复发性不稳的发生率很高。所有初次脱位或半脱位均需进行强化康复计划，但保守治疗失败后可能需要手术。必须谨慎准确地确定那些存在自愿性或多方向不稳的患者，此处应进行更长时间的保守治疗试验，因为这些病例的手术治疗效果较差。保守治疗应旨在加强肩关节的动态稳定器，尤其是肩袖肌肉。需要额外的X线片来显示与复发性不稳相关的所有放射学变化，在麻醉下检查和关节镜检查进行进一步评估对这些患者有益。关节镜手术在治疗有症状的盂唇病变患者中也有作用，现在也用于某些选定病例的稳定手术。已经描述了许多用于肩关节稳定的手术方法，这些方法应旨在纠正存在的病理状况。术后恢复患者的灵活性和力量至关重要，尤其是对于运动员，以便能完全恢复体育活动。
