The clinical assessment and classification of shoulder instability.

Assessment of the glenohumeral joint relies upon a detailed, time-dependent history of the presenting complaint and a thorough examination of its subtle signs. As such, the complex is most appropriately approached as a unit, rather than as a discrete number of examinable components. However, understanding the interactions between these components means that a high level of skill is needed to adequately assess the joint, and learning these skills is compounded by the large number of eponymous tests described for examining separate elements.The stabilising mechanisms of the shoulder may crudely be classified as passive (non-contractile) or active (contractile) in function; this artificial distinction neglects the role of contractile tissue in maintaining stability whilst not contracting, but serves to facilitate understanding, and indeed categorise modes and methods of physical examination. Indeed, modes of failure are specific to these groupings. Determining the degree of instability caused by the passive stabilising mechanisms is commonly fraught with both intra- and inter-rater discrepancy, and as such, requires a great deal of experience to implement and interpret. However, an evidence-based approach to a clinical examination sequence can improve its predictive value.A critical review of the literature on examination of passive stabilising mechanisms is presented, followed by a distillation of current concepts resulting in the presentation of an evidence-based approach to examination that is practical, and can be implemented successfully by all involved in the rehabilitation process. [ABSTRACT FROM AUTHOR]