Godbole Shrirang R, Vartak Devendra N, Indurkar Renuka S, Godbole Gayatri R
Department of Orthopaedics, Bharati Vidyapeeth (Deemed to be) University Medical College, Pune, Maharashtra, India.
Ameya Clinic- Centre for Orthopedics and Joint Surgery, 34/4 B, Erandawane, Pune 411004, Maharashtra, India.
J Orthop Case Rep. 2025 Sep;15(9):71-75. doi: 10.13107/jocr.2025.v15.i09.6020.
The glenohumeral joint, while offering a high degree of mobility due to its ball-and-socket design, is inherently unstable. Shoulder instability is particularly challenging in pediatric and adolescent populations, where presentations are often atypical and non-traumatic. Functional shoulder instability (FSI), especially when idiopathic and inferior in direction, is exceedingly rare and underrepresented in literature.
We report a unique case of a 15-year-old female who presented with chronic, atraumatic left shoulder subluxation, persisting over 18 months. The patient experienced pain and limited range of motion but reported no history of injury. Multiple prior consultations yielded temporary relief with analgesics, and no definitive diagnosis was established. Clinical evaluation revealed limited active abduction and external rotation with no signs of ligamentous laxity or neurological involvement. Radiographic assessment demonstrated gross inferior subluxation of the humeral head. Magnetic resonance imaging and computed tomography imaging confirmed intact soft tissue structures with mild joint effusion, anterior glenoid flattening, and a 6% glenoid bone loss. A diagnosis of inferior, non-positional, controllable idiopathic FSI was made, likely due to deltoid atony.
Management included temporary immobilization and physiotherapy using the Watson multidirectional instability protocol focused on scapular motor control retraining. After 10 weeks, the patient showed marked improvement with restoration of overhead abduction and full external rotation. Radiographs confirmed proper joint alignment, and the patient resumed normal activities symptom-free.
This case highlights a rare presentation of inferior idiopathic FSI in an adolescent. Early recognition and structured rehabilitation can lead to excellent outcomes, avoiding unnecessary interventions. Increased awareness of such atypical presentations is essential for prompt diagnosis and effective non-operative management.
盂肱关节因其球窝设计而具有高度的活动度，但本质上是不稳定的。肩部不稳定在儿童和青少年人群中尤其具有挑战性，因为其表现往往不典型且非创伤性。功能性肩部不稳定（FSI），尤其是特发性且方向为下向的，极为罕见，在文献中报道不足。
我们报告了一例独特的病例，一名15岁女性，出现慢性、非创伤性左肩关节半脱位，持续超过18个月。患者经历疼痛且活动范围受限，但无受伤史。此前多次会诊使用镇痛药获得了暂时缓解，未确立明确诊断。临床评估显示主动外展和外旋受限，无韧带松弛或神经受累迹象。影像学评估显示肱骨头明显向下半脱位。磁共振成像和计算机断层扫描成像证实软组织结构完整，有轻度关节积液、前盂唇扁平以及6%的盂唇骨质流失。诊断为下向、非位置性、可控制的特发性FSI，可能是由于三角肌无力。
治疗包括临时固定和采用沃森多向不稳定方案的物理治疗，重点是肩胛运动控制再训练。10周后，患者有明显改善，恢复了过头外展和完全外旋。X线片证实关节对位良好，患者无症状地恢复了正常活动。
本病例突出了青少年中罕见的下向特发性FSI表现。早期识别和结构化康复可带来良好结果，避免不必要的干预。提高对这种非典型表现的认识对于及时诊断和有效的非手术治疗至关重要。
