ISAKOS Consensus Shoulder Instability Classification System
After reviewing all of the classifications system for shoulder instability in current use, our committee concluded that there is no one single system in current use that could completely classify all shoulder instabilities. As in the case of the rotator c
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ISAKOS Consensus Shoulder Instability Classification System Kevin P. Shea
5.1
Background
After reviewing all of the classifications system for shoulder instability in current use, our committee concluded that there is no one single system in current use that could completely classify all shoulder instabilities. As in the case of the rotator cuff classification system, we reached consensus that a new system, based on elements of systems currently in use, was necessary to adequately classify most shoulder instabilities that are reported in the literature. Unlike rotator cuff tears that can be classified visually, instability is primarily a symptom. Thus, any instability classification system should include a classification of symptoms. Five factors were identified as being important in the classification of shoulder instability; 1. Frequency of recurrence, 2. Etiology of instability, 3. Direction of Instability, 4. Severity of instability, and 5. The Anatomic Lesion responsible for the instability. The FEDS system proposed and validated by Kuhn [1, 2] included most of these elements. Our current system is a modification of this system, and thus, a great deal of credit should be given to Dr. Kuhn. The Modified FEDS system is shown in Table 5.1. We felt that a broader definition of instability was necessary to be more inclusive of most conditions that clinicians currently define as instability. Kuhn defined instability as a feeling of both discomfort and a feeling of looseness, slipping, or shoulder ‘‘going out’’. These elements were included in many other definitions of instability [1, 2]. Using this definition, a shoulder condition that meets both criteria would be called unstable by most shoulder surgeons. However, the definition would specifically exclude the instability seen in the overhead and
K. P. Shea (&) University of Connecticut Health Center, Farmington Avenue 263, Farmington, CT 06034-4037, USA e-mail: [email protected] G. Arce et al. (eds.), Shoulder Concepts 2013: Consensus and Concerns, DOI: 10.1007/978-3-642-38097-6_5, Ó ISAKOS 2013
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K. P. Shea
Table 5.1 The modified FEDS classification for shoulder instability Direction
Etiology
Severity
Frequency
Anatomic lesionb
Anterior
Traumatic
Paina
Single episode
Capsule
Posterior
Required reduction
Subluxations
2–5 times
Labrum
Inferior
Never required reduction
Dislocations
[5 times
Bone
Locked
Locked
Atraumatic Involuntary Positional Habitual Repetitive Microtraumaa a
Only applicable to shoulder instability in the overhead and throwing athlete As determined by either pre-operative imaging studies (CT arthrogram, MRI, etc.) or intraoperative findings. A capsular lesion is diagnosed only if there are no labral avulsions or glenoid bone defects associated with the instability
b
throwing athlete. This group of patients usually complains of pain in the position of instability but not looseness [3]. They are felt to have ‘‘occult instability’’ or ‘‘multidirectional instability’’ because surgical procedures to reduce shoulder capsu
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