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UE Ortho

Shoulder Instability

QuestionAnswer
What is the most common type of instability? anterior instability
Anterior HH dislocation comprises __% of all dislocations. 90%
Anterior dislocation can occur from a blow to the ________ shoulder or a blow to the arm in a(n) _________ and ________ ________ position. posterior, abducted and externally rotated
Anterior instability can be caused by dislocation or what? repetitive abd/ER
Feeling of giving way, apprehension in the shoulder, or dead arm are chief complaints of what? anterior instability
What is often the primary complaint of a pt with anterior instability? instability in ABD/ER
If anterior instability is the result of a dislocation what may the pt also experience? sensory deficits secondary to concomitant nerve injury
The following are objective findings of what: increased ER ROM, decreased IR/horizontal ADD ROM, scap muscle weakness/RC weakness, increased anterior GH glide, decreased posterior GH glide anterior instability
This injury usually doesn’t reduce spontaneously and axillary nerve damage is not uncommon. Anterior dislocation of HH
Recurrence of anterior dislocation in pts <20 y/o is __% 94
Recurrence of anterior dislocation in pts >40 y/o is __% 14
After dislocation, are younger pt immobilized longer than older? How long are each immobilized? young=4-6 weeks Old=7-10 days
When HH dislocates anteriorly, the posterior aspect of the HH can come into contact with the anterior glenoid, causing damage to the posterior HH often resulting in an impaction fracture...what does this describe? Hill Sachs Lesion
Manipulation of the _________ and a _______ force applied at the wrist are two ways to reduce a dislocated shoulder. scapula, traction
What was the success ratio with the scapular manipulation for shoulder reduction? 47/51
What are the three categories of other "flavors" of instability? 1. recurrent traumatic, 2. Acute atraumatic dislocation, 3. recurrent atraumatic
There is a Grade __ recommendation available to guide medical/surgical management in young adults engaged in demanding physical activities who have sustained their first acute traumatic shoulder dislocation. B
What is the benefit of surgical intervention for younger pts who have sustained their first acute traumatic shoulder dislocation? It reduces the number of episodes of instability and recurrent dislocation.
What grade of recommendation is available for both surgical and non‐surgical rehabilitation following anterior glenohumeral instability? grade D
For an acute traumatic dislocation, what might the emphasis of rehab be in order to prevent reccurence? Isokinetic IR & AD exercises at 3 weeks
For a conservative approach to an acute traumatic dislocation how long would you immobilize the pt? 3 weeks
For a conservative approach to an acute traumatic dislocation when would you start isometric contractions? at 2 weeks
For a conservative approach to an acute traumatic dislocation how long would you have the pt in a sling? 2-3 weeks
With a conservative approach to an acute traumatic dislocation how long does it take the pt to return to sports? 3 months
With a conservative approach to an acute traumatic dislocation what is the reccurence rate? 25%
What are the conservative tx principles for acute traumatic dislocation? ROM progression, pain control, scapular stabilizing strengthening, add GH motion to scapular motion, then RC strengthening to maintain HH in glenoid
What position do you want to begin your tx for anterior instability? Progress to what position? ADD/IR, progress to ABD/ER
If there is axillary n involvement you may need to do reeducation or strengthening of what muscles? delt/T minor
In the operative stabilization study done on the West Point group, what percent of participants remained stable at 5 years? 85%
In the operative stabilization study done on the West Point group, what percent of participants developed recurrent instability? 15%
What surgical intervention involves taking up slack in the capsule? Neer capsular shift
Surgical repair of any glenoid disruption(capsule, labrum, etc) is called what? Bankart repair
When talking about surgical interventions for instability, it is important for us know about 4 things. What are they? what structures were stabilized, what positions stress the structure, healing time for the structure, fixation of the structure.
Does evidence show that arthroscopic surgery is more effective that open surgery? no(evidence doesnt support either sx over the other)
Is posterior dislocation common? no(<5%)
Falling on an out stretched hand can lead to dislocation in what direction? posterior
If sxs increase in combined flex, ADD, and IR, the pt likely has what? posterior instability
Increased IR and horiz add ROM, Scapular and RC weakness, and Increased posterior GH glide are all indicative of what? posterior instability
What special test would you do for posterior instability? posterior glide, load and shift
T or F, with instability in one direction, will often have decreased ROM or capsular tightness in opp? T
With dislocations and instabilities you would initially avoid motions in _____ direction, but eventually progress when stable. Direction of instability(ie. Avoid horiz add/ir with post instability).
What are the progression of tx principles for post instability/dislocation? Immobilization, pn control, STR (scap stabilizers, RC, biceps), avoid activities in direction of instability and later progress
Post dislocation MOI: FOOSH in horiz add/ir position (most common), Or ant blow to shldr
____= common complaint for ant dislocation, while ____= more common complaint for post dislocation. Ant = instability; post= pn
Created by: txst fall 2009