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MSK Exam 3 > Dislocation > Flashcards

Dislocation Flashcards

1
Q

What is the most dislocated joint?

A

Glenohumeral Joint

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2
Q

What is the most common direction for a GH dislocation?

A

Anterior

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3
Q

What is the etiology of an anterior GH dislocation?

A
  • Mechanism: External rotation and abduction with FOOSH (fall on an outstretched hand)
  • Anterior-inferior direction of humeral head
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4
Q

What is the etiology of a posterior GH dislocation?

A
  • Less common 2-4%
  • Mechanism: 90 degrees of flexion with a FOOSH
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5
Q

What is the third etiology for GH dislocations? (hint: not anterior or posterior)

A

Recurrent

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6
Q

What are the structures involved in a dislocation?

A
  • Stretch or tear of the capsule or ligaments
  • Other possible damage: an anterior labrum tear (aka a bankart lesion) or a SLAP tear
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7
Q

What types of impingement are likely to result from dislocations? (hint: hypo or hyper)

A

Hypermobile

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8
Q

In a bankart lesion the humeral head dislocates in what direction?

A

Anterior - Inferior (chip off the front)

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9
Q

A SLAP tear is located where?

A

The superior portion of the labrum below the biceps tendon

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10
Q

Fibrocartilage is described as having a _____ outer portion and a _____ inner portion.

A
  • Thick outer, thin inner
  • Thicker and concave compared to articular cartilage
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11
Q

Fibrocartilage helps to do what for the joint surface

A

Widen and deepen it

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12
Q

Fibrocartilage is located where?

A
  • The shoulder and hip
  • SC, tibiofemoral, AC, ulnotriquetral, intervertebral, and pubic symphysis joints
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13
Q

What are the structures of fibrocartilage?

A
  • Fibro and chondrocytes
  • Collagen
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14
Q

What is the function of the outer collagen (primarily type 1 collagen)?

A
  • Resists tension for stabilization
  • Majority type for all fibrocartilage, including with glenoid labrum
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15
Q

What is the function of the inner collagen (secondarily and less type 2, 3, and 4 collagen)?

A

Resists compression for shock absorption

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16
Q

Which part of the fibrocartilage (outer or inner) is made up of vascular and neural tissue?

A

The outer

17
Q

What are the neural attributes of the outer fibrocartilage used for?

A
  • Proprioception
  • Kinesthesia like ligament
  • Annulus for stabilization
18
Q

If the outer part of the fibrocartilage is neural and vascular that makes the inner?

A

Hypo- or avascular, aneural, and alymphatic

19
Q

What is the etiology of fibrocartilage injuries?

A
  • Acute tears with RTC tears and dislocations
  • Gradual tears from repetitive and or extreme motions and compressive stresses. often with sports and impingement
20
Q

What does healing looking like for fibrocartilage?

A
  • Better at the periphery due to greater vascularity
  • Tensile strength initially improves at 3-5 weeks
  • Even greater tensile strength when dense fibrous tissue fills in at 8-12 weeks
21
Q

What is your MET focus for fibrocartilage?

A
  • Tissue integrity/ proliferation with vascularity issues
  • Stabilization due to stabilizing roles of fibrocartilage
22
Q

What other damage or complications can be found with damage to the fibrocartilage?

A
  • Fractures (aka hill sachs lesion - compression fracture of the humeral head)
  • RC tear
  • Neurovascular structures
23
Q

Dislocations are like impingements plus …

A
  • Trauma in characteristic position
  • Acute presentation
24
Q

Dislocations have signs like impingements plus what other things?

A
  • ROM: limited and painful in most directions
  • Resisted and MMT: weak and painful in most directions
  • Stress tests: likely (+) depending on structures involved
25
Q

For an anterior dislocation you can have possible (+) special tests for a labrum. With an anterior instability what will you see?

A
  • LR+ = 39.68 if both (+) or LR-= .19 if both (-)
  • (+) apprehension
  • (+) relocation
  • Apprehension may also be positive with general hypermobility
26
Q

For an anterior dislocation you can have possible (+) special tests for a labrum. With an anterior labrum what will you see?

A

Speed’s: high sensitivity

27
Q

For an anterior dislocation you can have possible (+) special tests for a labrum. With a posterior inferior labrum what will you see?

A

Jerk Test - LR+ 1.25-36.5

28
Q

What are the possible (+) special tests for a labrum?

A
  • Sulcus with inferior drawer: high specificity
  • Biceps load 2 (LR+ = 1.36-26.38; LR- = .11-.9)
  • Pain provocation: high specificity
  • Passive compression (LR+ = 5.72; LR- = .21)
  • Yergason’s: high specificity
29
Q

What are possible (+) special tests for a fracture?

A
  • Olecranon-Manubrium Percussion Tests: Highly specific/sensitive, LR+ 84
  • Bony Apprehension Test (I.e. Bankart or Hill-Sachs): LR+ = 5.88; LR- = .07
30
Q

What is the PT RX for dislocations?

A
  • Treat as a worse cases of impingement due to hypermobility/ instability
  • Immobilization up to 6 weeks
  • POLICED
  • Improve rotator cuff activation with contralateral UE use and ipsilateral hand squeezing activities
31
Q

With immobilization, shorter periods favor what?

A
  • Muscle integrity
  • Proprioception
  • Peripheral and central neural activity
  • Dynamic stability
32
Q

What is the MET focus for dislocations?

A
  • Stabilization
  • Tissue integrity and proprioception
33
Q

For anterior dislocations what movements are initially contraindicated?

A

Flexion, external rotation, and abduction ROM are initially contraindicated

34
Q

For anterior dislocations what motions do you focus on?

A

Isometrics and isotonic into the opposite directions because they wont be guarding in this direction (gain their trust first)

35
Q

Recurrent dislocations are highly likely if the patient is below what age?

A

30

36
Q

What can the MD do to help with dislocations?

A
  • Arthroscopic vs open reduction
  • Typically, 3-6 months prognosis
  • Full ROM under anesthesia
  • Follow protocols
37
Q

What is a coracoid transfer?

A

Repositioning of the coracoid process and coracobrachialis and short biceps head to the GH neck

38
Q

What is a capsuloraphy?

A
  • Aka a capsular shift
  • Most common MD treatment
  • Overlap of town portions of capsular folds

MSK Exam 3 (9 decks)

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