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MSK 1 > 9/30 - Shoulder Instability Non-Op > Flashcards

9/30 - Shoulder Instability Non-Op Flashcards

1
Q

what direction is the GH joint deeper in

A

superior-inferior

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2
Q

describe the GH joint’s set up

A

least constrained joint in body

glenoid surface 1/4 surface area of humeral head
- 1/3 of humeral head in contact w fossa at any given time

bony congruence limited

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3
Q

what is the significance of limited bony congruence in the GH joint

A

relying on other structures to stay centered

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4
Q

describe how the quality of the glenoid articular cartilage changes

A

thicker peripherally

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5
Q

GH laxity

A

ability to translate humeral head on glenoid fossa

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6
Q

GH instability

A

unwanted and excessive translation of humeral head on glenoid fossa causing alteration in comfort and/or function

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7
Q

subluxation

A

complete separation of articular surfaces w spontaneous reduction

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8
Q

dislocation

A

complete separation of articular surfaces without spontaneous reduction
- remains dislocated until maneuver or force

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9
Q

how is time crucial when it comes to relocation of a dislocation

A

longer it takes, higher the risk of neurovascular injury
- tension and load on brachial plexus and vascular
- longer it’s there, harder to come back (esp for nerves)

this factors into our goals
important to ask if dislocation how long it was out of place for

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10
Q

where do you see the biggest difference in ROM in normal laxity vs normal shoulder w no laxity

A

inferior slightly more in normal laxity
- anterior and posterior will be pretty much the same as a normal shoulder

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11
Q

what structures provide stability for the shoulder (7)

A

labrum
ligaments & capsule
biceps
rotator cuff
scapula
neuromuscular control
negative intra-articular pressure

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12
Q

if someone had a shoulder dislocation, what should you assess next

A

if any of the stability structures were damaged
- labrum
- ligaments & capsule
- biceps
- rotator cuff
- scapula
- neuromuscular control
- negative intra-articular pressure

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13
Q

what is the labrum

A

fibrocartilage surrounding glenoid rim

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14
Q

what functions does the labrum provide (3)

A
  1. attachment site for glenohumeral capsule and ligaments
  2. chock-block effect that limits translation
  3. inc depth of glenoid fossa by 50%
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15
Q

what happens if the labrum is damaged

A

back to a shallow glenoid fossa w poor bony congruence and stability

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16
Q

what is the function of ligamentous structures and capsule

A

provide stability at end ranges of motion

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17
Q

what ligamentous structures are involved in the shoulder

A

coracohumeral ligament
superior GH ligament
middle GH ligament
inferior GH ligament
- anterior and posterior bands

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18
Q

what ligament of the shoulder has a hammock effect? what does this mean?

A

inferior GH ligament
- anterior and posterior band

as bring arm up to ABD 90 there is tension in inferior; anterior and posterior will come up to hug front and back

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19
Q

how are the ligaments of the shoulders structured

A

thickenings of capsule

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20
Q

what is the circle of stability concept

A

what happens if one is damaged depends on integrity of other structures there

ex: cut anterior capsule
whether it dislocates anterior:
- dependent on posterior capsule integrity
- inc translation or subluxation

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21
Q

what provides primary restraint in early ROM

A

negative intra-articular pressure

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22
Q

what provides primary restraint in mid-range

A

muscle function

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23
Q

what provides primary restraint in end range

A

capsule
- no tension on passive structures prior to this range

24
Q

what is the structure of the long head of biceps

A

blends w superior glenoid labrum

25
Q

origin of long head of biceps function (3)

A

stabilizes arm in ABD and ER
generates joint compressive forces

dec anterior, superior, and inferior translation of humeral head when taut

26
Q

if seeing an overuse injury in biceps but not an event to cause overuse, what should you think and why

A

might be bc of hypermobility
- if underlying shoulder hypermobility, will work harder to create stability via compressive forces&raquo_space; leading to some biceps irritation

27
Q

what is the primary role of the rotator cuff

A

provides dynamic stabilization by compressing humeral head into glenoid

28
Q

where do RC ms insert into and why is this important

A

blend w capsule & creates dynamic ligament tension

if laxity in ligamentous structures, the RC ms working can create stability via dynamic ligament tension

29
Q

what is the function of scapula upward rotation

A

provides stable environment of joint contact

30
Q

what other motions do you see at the scapula during upward rotation/elevation

A

ABD and tilts posteriorly

31
Q

what is required for distal mobility

A

proximal stability

32
Q

what is proximal stability needed for

A

distal mobility

33
Q

what are the advantages to exercises done in the scapula plane (4)

A

inc stability w joint congruence
- good bony stability
- good stability of capsular ligamentous
minimal capsular tightness
functional plane of motion
ideal position for RC strengthening

34
Q

what is the scapula plane referring to

A

position of the glenoid

35
Q

what are components contributing to neuromuscular control

A

efferent/motor responses to afferent/sensory info

36
Q

proprioception

A

awareness of joint position

37
Q

kinesthesia

A

awareness of joint motion

38
Q

why are we concerned if a person w an unstable shoulder has poor proprioceptive and kinesthetic sensation

A

when brain doesn’t know where joint is in space, inc risk for injury
- won’t tell you when in an end range injury provoking situation and won’t enact protective measures (ie late cocking phase)

39
Q

what is negative intra-articular pressure

A

creates sealed compartment
vacuum effect b/w articular surfaces
- compresses head of humerus

40
Q

why is negative intra-articular pressure lost w surgery and why is this important

A

surgery cutting thru capsule, will be venting it
- inc mobility, 40-60% inc in translation

41
Q

why are AMBRI joints best served by a PT intervention instead of surgery

A

if tighten structures in surgery, likely stretch back out over time

42
Q

what are considerations for instability (8)

A

severity
direction
etiology
frequency (# of episodes)

+/- underlying soft tissue laxity or connective tissue disorder

concomitant path
end-range NM control
premorbid activity level

43
Q

what about the severity of the instability should be considered

A

subluxation
- physiologic integrity exceeded
dislocation
- physiologic & anatomic integrity exceeded

44
Q

direction of instability possibilities?

A

unidirectional
multidirectional (MDI)

45
Q

etiologies for instability

A

traumatic
atraumatic

46
Q

frequencies for instability

A

primary
recurrent

47
Q

why does it take less for a subsequent dislocation or subluxation

A

load on passive structures will stretch out
won’t take as much load for same things to happen

48
Q

what are concomitant pathologies for instability

A

SLAP lesion
bankart lesion

49
Q

SLAP vs Bankart

A

SLAP - superior labrum anterior posterior
Bankart - anterior inferior damage

50
Q

what is a commonly associated w a hill-sachs lesion? why?

A

associated glenoid bone loss

HOH rolls over rim of glenoid when dislocates
- compressive forces that damage the glenoid (bone and cartilage loss)

51
Q

why is there value to imaging if a dislocated shoulder has already been relocated

A

see integrity of the bone
- if there is bone loss, can continue to waste away

52
Q

what is a SLAP lesion

A

disruption of superior labral-biceps complex involving tearing, separation or both of the superior labrum beginning posterior to biceps tendon insertion and then extending anteriorly

53
Q

what is the peel back mechanism

A

ABD & ER in late cocking phase of throwing

twisting at base of biceps
transmits torsional force to anchor

54
Q

what is a concern w traumatic anterior instability

A

brachial plexus injuries (esp axillary n.)
- humerus comes out the front
- that is where the NM structures are

55
Q

what is a negative to the use of slings

A

minimize strength and motor control from disuse
- more for comfort usually

MSK 1 (31 decks)

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