Rockwood Adults CH34

1082

SECTION TWO • Upper Extremity

Furthermore, the FEDS system of classification was assessed for both inter-observer and intra-observer agreement between six sports medicine trained physicians in 48 patients with shoulder instability. Intra-observer agreement was 84% to 97% (k 0.69 to 0.87) and inter-observer agreement was 82% to 90% (k 0.44 to 0.76), representing substantial to excellent agreement. 127

ETIOLOGY—The patient is asked, “Did you have an injury to cause this?” a. Traumatic—“Yes” b. Atraumatic—“No” DIRECTION – The patient is asked, “What direction does the shoulder go out most of the time?”

a. Anterior—“Out the front” b. Inferior—“Out the bottom” c. Posterior—“Out the back”

Glenohumeral Instability: OTA CLASSIFICATION Glenohumeral joint (10-A) 1. Anterior dislocation (10-A1) 2. Posterior dislocation (10-A2)

SEVERITY—The patient is asked, “Have you ever needed help getting the shoulder back in joint?”

a. Subluxation—“No” b. Dislocation—“Yes”

3. Lateral (theoretical) dislocation (10-A3) 4. Medial (theoretical) dislocation (10-A4) 5. Other (inferior—luxatio erecta) (10-A5)

The FEDS (Frequency, Etiology, Dislocation, Severity) clas- sification system for shoulder instability was developed by Dr. Kuhn at the Vanderbilt University Medical Center. 126 This is the only classification developed from a systemic review of the literature to determine which features of instability were used most commonly by the other proposed classifications in the literature for shoulder instability. Of all the criteria, four features were seen in more than 50% of the proposed classi- fication systems: frequency, etiology, direction, and severity. Interestingly, these four features also reflected the results from a survey of the American Shoulder and Elbow Surgeons (ASES).

The Orthopaedic Trauma Association (OTA) classification is based on the direction of instability (Fig. 34-25). The gle- nohumeral joint is designation 10-A. Anterior dislocation is classified as 1, and thus the OTA classification is 10-A1. For posterior dislocation, it is 2, or 10-A2. Both medial and lateral dislocations are theoretical classifications and not typically seen in clinical dislocations. Inferior dislocation is rare, also termed luxatio erecta and classified as 10-A5.

Anterior dislocations (10-A1)

Posterior dislocations (10-A2)

B

A

C

D

Other dislocations (inferior-luxatio erecta) (10-A5)

Figure 34-25.  OTA classification is based on the direction of instability. The glenohumeral joint is designation 10-A. Anterior dislocation is classified as 1, and thus the OTA classification is 10-A1. For posterior dislocation, it is 2, or 10-A2. Both medial and lateral dislocations are theoretical classifications and not typically seen in clinical dislocations. Inferior dislocation is rare, also termed luxatio erecta and classified as 10-A5. Anterior gle- nohumeral dislocation seen in AP view ( A ) and scapular Y view ( B ). Posterior glenohumeral dislocation seen in AP view ( C ) and scapular Y view ( D ). Inferior glenohumeral dislocation seen in AP view ( E ) and scapular Y view ( F ).

E

F