This case series introduces functional glenohumeral instability, where a partially attached labral fragment catches between the joint surfaces without the humeral head leaving the glenoid. It separates this from anatomical instability (subluxation and dislocation) and links each type to a specific operation. It also presents the glenohumeral axillary arthrotomogram as a sensitive test for labral tears.
When a patient has a mechanically catching, clicking, or locking shoulder after injury but no history of the shoulder coming out, think functional instability from an interposed labral fragment, not subluxation.
The decision rule this paper establishes still holds conceptually: examination under anesthesia tells you which operation to do. A stable joint with a torn labrum means excise the fragment alone. An unstable joint means repair plus capsulorrhaphy.
Getting this right avoids an unnecessary capsulorrhaphy, which needlessly tightens the shoulder and slows recovery. That matters most for the throwing athlete who needs full external rotation.
This is early work in the arc toward modern arthroscopic labral surgery. The axillary arthrotomogram it champions has been replaced by MR arthrography and arthroscopy, but the core teaching point endures: not every symptomatic labral tear means the shoulder is unstable.
This case series introduces functional glenohumeral instability, where a partially attached labral fragment catches between the joint surfaces without the humeral head leaving the glenoid. It separates this from anatomical instability (subluxation and dislocation) and links each type to a specific operation. It also presents the glenohumeral axillary arthrotomogram as a sensitive test for labral tears.
When a patient has a mechanically catching, clicking, or locking shoulder after injury but no history of the shoulder coming out, think functional instability from an interposed labral fragment, not subluxation.
The decision rule this paper establishes still holds conceptually: examination under anesthesia tells you which operation to do. A stable joint with a torn labrum means excise the fragment alone. An unstable joint means repair plus capsulorrhaphy.
Getting this right avoids an unnecessary capsulorrhaphy, which needlessly tightens the shoulder and slows recovery. That matters most for the throwing athlete who needs full external rotation.
This is early work in the arc toward modern arthroscopic labral surgery. The axillary arthrotomogram it champions has been replaced by MR arthrography and arthroscopy, but the core teaching point endures: not every symptomatic labral tear means the shoulder is unstable.