Problem A: Shoulder Instabilities
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| What is the most common joint for dislocations? | the shoulder GH joint
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| What is the most common type of shoulder dislocation? and the most common type of dislocation in the body! | anterior
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| The 2 mechanisms of injury for a shoulder dislocation are primary and secondary. What is a primary dislocation? | Primary - caused by forced ER and ext of the shoulder causing the HH to be driven forward, tearing GH ligaments and sometimes labrum. the ridge can be chipped and crank test (+) ... in notes it says ER and ABD
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| The 2 mechanisms of injury for a shoulder dislocation are primary and secondary. What is a secondary dislocation? | may be caused by FOOSH or a fall on the posterolateral aspect of shoulder
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| Name the 4 different types of anterior shoulder dislocations. | Bankheart lesion: ant capsule defect (85%), Hillsat: post/lat defect of humeral head (38%), Fx of glenoid which causes ant dislocation, Rupture of subscapularis
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| What are the signs and symptoms of anterior instability @ the shoulder? | Hx of previous dislocations, Position before it happened (ER, EXT, ABD?), Pt is unable to use arm which tends to be supported with opposite hand, Square appearance of shoulder, Prominent acromion, xray confirmation
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| What are some complications resulting from an anterior shld instability problem? | axilary art and nerve damage, rotator cuff tear
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| What are some causes of anterior instability recurrence? | Glenoid aplasia, Glenoid/humeral anteversion (bone altered), Ms imbalance, Jt cap laxity, Ms damage (subscapularis), Rim of glenoid being chipped away, Humeral head defect, Anterior Instability
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| What are the treatments for anterior instability of the shoulder? | 1. Reduction 2. Immobilized in sling 3. Following immobilization • Strengthening for rotator cuff ms & stabilize the humerus• ROM to maintain not force end ROM4. Surgical procedures• When all else fails • To tighten up soft tissue
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| What type of surgery to correct anterior instability involves reinforcement of the anterior capsule by overlapping the subscapularis muscle and capsule to prevent excessive ER? | Putti-Platt & Magnusion-Sack
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| What type of surgery is a repair of the anterior capsule where the labrum and capsule are reattached to the anterior margin of the glenoid cavity? | Bankart
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| What type of surgery involves a bone block which blocks anterior displacement of the HH? | Eden-Hybbinnette & Bristow Helfet
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| What type of surgery involves an infraspinatus transfer? | Connelly
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| What type of surgery to correct anterior shoulder instability uses a humerus osteotomy? | Weber
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| What types of osteotomies can be done to correct anterior instability? | humerus osteotomy (Weber) and glenoid osteotomy...these are less common compared to the Bankart and Putti Platt
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| Stevie Sixpack fell on his R hand with his shoulder in ADD and IR and dislocated his shoulder. What type of dislocation was it? | posterior
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| Falling on the anterior portion of the shoulder may result in this type of dislocation. | posterior
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| Axial loading with the arm in IR and ADD may result in what type of dislocation? | posterior
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| What are the signs and symptoms of a posterior shoulder dislocation? | No gross deformity, pt. resists any motion of shoulder, Arm seems locked in ADD, IR, ER, More fullness of the HH felt posterior, A-P view is NOT helpful for detection on radiograph, axillary view is
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| Posterior instability may occur as a secondary injury of what structures? | Post capsule injury, Glenoid labrum, or Humeral head
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| What are some of the complications that can result from posterior instability? | Fx of the ant/med humeral cap, Fx Post rim of glenoid, Fx Lesser tuberosity, Fx Prox humerus
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| Which type of instability does not have that high of a rate of recurrent injuries? | posterior - recurrent post instability injuries are rare b/c the shldr has more support post than ant...if post recurrence is seen there may be a congenital abnormality
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| What is the Rx for Posterior shld instabilities? | 1. Reduction as soon as possible2. Sling for 3 weeks3. Surgery to remove fx fragments or fixation of fracture4. Surgery to correct recurrent dislocation
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| What types of surgeries can be done for posterior recurrent instabilities? | a. reverse Putti-Plattb. Boyd-Sisk – biceps transferc. Reverse Eden – Hybbinette d. Glenoid osteotomy
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| what are the mechanisms of injury for inferior shoulder instability? | 1. Arm is forced into ABD (to ear)2. Lateral neck of humerus inpinges3. Subacrominal dislocation
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| Inferior instability may occur as a secondary injury of what structures? | – Inferior capsule– Gleno-humeral ligament– Glenoid labrum– Luxation Erecta
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| Tell me everything you know about Luxation Erecta. | Same as inf dislocation except arm is forced overhead (extreme version of inf dislocation), the joint capsule & rotator cuff ms have lost integrity, HH locks under the glenoid, can occur as a result of diving, need a lot of force to cause this injury
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| What is the Rx for luxation erecta? | surgery
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| Whats the deal with multidirectional instability? | Generalized ligament laxity & chronic instability, Force is more significant therefore u get more trauma to the area, – Acute dislocation/subluxation, Can occur from multiple micro trauma, Seen more in traumatic situations, Other jt dysfn seen
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| What is the Rx for multidirectional instability? | surgery
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| What do atraumatic dislocations occur as a result of? | Excessive laxity of the jt causing loss of cohesion, jt can’t hold bone inside capsule
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| What is the treatment for atraumatic dislocations? | Strengthening & stabilization exercises (body blade), Surgery alternative
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| Some Rx for your good old voluntary dislocator include what? | Exercise, Education that it is not good to do & could be more problematic, Biofeedback/NMES for strengthening
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| What type of subluxation has the following symptoms?...– Causes dead arm syndrome b/c of pressure on nerve, Can’t lift arm secondary to pain in deltoid region | anterior subluxation
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| Describe the etiology of anterior subluxations. | when shoulder ER & abd, ant & inf ligs affected, humeral head forced ant, humeral head starts to move over glenoid rim, often experience sprain of ligs on the ant portion of the capsule
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| Describe the etiology of posterior subluxations. | direct backwards thrust of humerus w/ elbow flexed, causes damage to post part of rotator cuff, Difficult to diagnose
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| How would you treat posterior shoulder subluxations? | immobilization, protection (sling), strengthening ER, surgery final option but not very common
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| What is the etiology of an inferior shoulder subluxation? | humeral head slides inf & hands out on the underside of glenoid, rides on glenoid rim
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| What is the Rx for inferior shoulder instability? | strengthening after immobility, surgery last resort
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| What happens with shoulder separation at AC joint? | severe fall on top of shoulder, Acromion driven down, Clavicle pulled upward by muscle action. Observation: clavicle in different spot, take X-ray w/ person holding something in hand
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| What is the Rx for AC joint ligamentous tear? | Strapping or sling, Surgery last resort
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| What structures are affected with the sub-acrominal impingment? | ↑ in volume of structures under the subacrominal arch (rotator cuff ms (Supraspinatus & biceps), may see bursitis, tendonitis, Inadequate depression of the HH during elevation, Tightened superior capsule or coracohumeral ligament
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| A Rx for sub-acrominal impingment may include this... | work on inflammation issues w/ NSAIDS
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| What does a SLAP Lesion stand for? | superior labrum anterior Posterior (to the biceps)Instability Associated w/ ant instability & pain
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| WHat is an anterioinferior labral tear AKA? | Bankart Lesion
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| How do you treat a Bankart Lesion? | surgery
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| What type of SLAP lesion has the superior labrum markedly frayed but attachments intact. | Type 1
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| What type of SLAP lesion has superior labrum with a small tear and there is instability of the labral biceps complex ? | Type 2
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| What type of SLAP lesion is the most common? | Type 2
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| What type of SLAP lesion does not need surgery? | Type 1
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| What types of SLAP lesions nees surgery? | Types 3 and 4, type 2 can do a scope instead
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| What type of SLAP lesion involves a bucket-handle tear of labrum that may displace into jt; labral biceps attachment intact. | Type 3
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| What type of SLAP lesion involves a bucket handle tear of labrum that extends to biceps tendon, allowing tendon to sublux into jt. | Type 4
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| What is the most common ms involved in a rotator cuff tear? | Supraspinatus
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| What impairements can someone get as a result of a rotator cuff tear? | Loss of vascularization, Sub-acrominal impingement b/c of the ms tear
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| What factors will you see overuse and impingment syndrome in athletes? | – Mechanism of injury: compression & irritation– Pts have pain w/ over head reaching activities & arc– Do to excessive overhead repetitive overuse activities– Seen in people w/ subluxation issues– Common w/baseball pitcher, swimmers
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| In what population and gender is adhesive capsulitis more common? | older women
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| How do you treat adhesive capsulitis? | Avoid total immobilizationProper exercise ADLs performed correctly (good posture)No overuse
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| How do you treat Thoracic outlet syndrome? | Proper postureExerciseADL performed correctlyProper biomechanics
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