Arthroscopic Load-Shift Technique for Intraoperative Assessment of Shoulder Translation

Abstract

Shoulder instability represents a spectrum of disease, ranging from subluxation to dislocation. It may present acutely after trauma or chronically as a result of multiple events. Physical examination is a key component in evaluating the degree of instability and laxity present; however, in-office guarding or apprehension may limit the examination. In addition, patient anatomy or operator technique may limit the accuracy and reproducibility of examination maneuvers such as the load-shift test. We propose an arthroscopic modification to the load-shift technique involving direct visualization to assess the direction and degree of shoulder instability. Our technique allows for the examination of a fully relaxed, anesthetized patient, eliminating guarding, and allows for intraoperative documentation of the patient's laxity both before and after surgical stabilization. In addition, this allows for custom titration of adjunctive capsulorrhaphy in arthroscopic stabilization cases.