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DPT MSK - fall 22 > Dislocation - Proximal Humeral Apophysitis - Exam 3 > Flashcards

Dislocation - Proximal Humeral Apophysitis - Exam 3 Flashcards

1
Q

what joint is the most dislocated?

A

GH jt

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2
Q

what is the most common direction a dislocation happens? mechanism?

A

anterior - ant/inf direction
ER and ABD with FOOSH

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3
Q

how would a posterior dislocation happen?

A

90 deg flexion with FOOSH

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4
Q

what structures are involved with a dislocation?

A

stretch, tear capsule, ligament
other possible damage:
- anterior labrum tear (Bankart lesion, anterior movement of humeral head)
- SLAP lesion

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5
Q

compare fibrocartilage vs articular cartilage

A

thicker and concave
- outer portion is thick
- inner portion is thin
- widens and deepens joint surface

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6
Q

what locations are where fibrocartilage is a dominant tissue?

A

shoulder and hip labrum
SC, tibiofemoral, AC, ulnotriquetral, intervertebral, pubic symphasis

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7
Q

in fibrocartilage, outer collagen is primarily what type? what does it do?

A

type I collagen
resists tension for stabilization
majority type in ALL fibrocartilage

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8
Q

in fibrocartilage, inner collagen is secondarily what type? what does it do?

A

type II, III, IV collagen
resists compression for shock absorption

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9
Q

fibrocartilage is like what other structure we have learned about?

A

annulus –> outer type I, inner type II

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10
Q

the outer fibrocartilage is what kind of tissue?

A

vascular and neural tissue
neural attributes for proprioception/kinesthesia like ligament/annulus for stabilization

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11
Q

the inner fibrocartilage is what kind of tissue?

A

hypo- or avascular/aneural/alymphatic (resist compression)

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12
Q

what happens to fibrocartilage after trauma?

A

tears possibly with RC tear/dislocations

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13
Q

why is fibrocartilage better at periphery healing?

A

due to greater vascularity

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14
Q

tensile strength initially improves at _______ weeks
greater tensile strength improves when dense fibrous tissue fills in at ______ weeks

A

3-5 weeks
8-12 weeks

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15
Q

what would your MET be focused on for fibrocartilage Rx?

A

tissue integrity/proliferation with vascularity issues
stabilization due to stabilizing role of fibrocartilage

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16
Q

what other damage could occur with dislocation?

A

fracture aka Hill Sachs Lesion - compression fracture of humeral head
RC tears
neurovascular structures

17
Q

what are symptoms of dislocation?

A

trauma in characteristic position
acute presentation

18
Q

what would the scan findings be for dislocation?

ROM?
resisted/MMT?
stress tests?

A
  • limited and painful most directions
  • weak and painful most directions
  • likely (+) depending on structure involved
19
Q

what are possible (+) tests for labrum dislocation? fracture dislocation?

A

labrum dislocation:
anterior instability
anterior labrum
postero-inf labrum
SLAP

fracture dislocation:
olecranon-manubrium percussion test
bony apprehension test (Bankart or Hill-Sachs)

20
Q

what is the main prescription for dislocations?

A

immobilization & POLICED
- up to 6 weeks
- improve rotator cuff activation with contralateral UE use and ipsilateral hand squeezing activities
- shorter periods are favored

21
Q

What would MET focus on for dislocations?

A

stabilization
tissue integrity and proliferation

22
Q

for an anterior dislocation, which motions should you check to be ok first? Why?
which motions are initially contra-indicated?

A

IR, EXT, ADD
These directions are opposite of the painful motions from a dislocation
contraindicated: ER, FLX, ABD

23
Q

why would you perform isometrics and isotonics into opposite directions initially for an anterior dislocation?

A

start away from direction that is hurt
sensitive spindle to make aware of muscle contraction

24
Q

what is the prognosis for a dislocation? recurrent dislocations are highly likely if patient is < ______ years?

A

not all injuries are the same so healing time is not always the same
< 30 years

25
Q

what are MD Rx for dislocations?

A

arthroscopic vs open procedure
3-6 months prognosis
Full ROM under anesthesia
follow protocols

26
Q

what is a coracoid transfer?

A

reposition coracoid process and coracobrachialis and short biceps head to GH neck

27
Q

what is the most common MD Rx for a dislocation?

A

capsular shift aka capsuloraphy
overlap of torn positions of capsular folds

28
Q

proximal humeral fractures are most common in? how does it happen? what structure is it most common at?

A

elderly
FOOSH
surgical humeral neck

29
Q

what are two complications of a proximal humeral fracture?

A

axillary artery damage
– coldness & blanching
– emergency referral
– possible avascular necrosis

adhesive capsulitis from prolonged immobilization

30
Q

what is the cause of a clavicular fracture?

A

compression mechanism thru long axis of clavicle at the weak spot at S curve

31
Q

what are 2 complications of a clavicular fracture?

A

large displacement may require surgery
epiphyseal plate (growth plate) injury because it is last to ostify (18-25 years)

32
Q

when would you typically start PT for a fracture?

A

4-8 weeks when clinical union occurs (cartilage patch turns to bony patch)

33
Q

what is proximal humeral apophysitis? how is it caused?

A

little league shoulder - middle/high school overhead athletes (males)
UE growth plate disfunction - inflamed or separated
caused by growth with high activity

34
Q

what are pathomechanics of proximal humeral apophysitis?

A

bone growth exceeds rotator cuff lengthening
increased tendon tension
growth plate is weak spot as opposed to tendon
most often inflammation
complications - avulsion and/or premature closure

35
Q

what are symptoms of proximal humeral apophysitis?

A

gradual onset of shoulder pain with overuse
a pop may indicate trauma and avulsion
possible loss of velocity

36
Q

what would PT find with proximal humeral apophysitis?

_________ like
resisted/MMT:
special tests:
palpation:

A

impingement like
lower ER/IR strength ratio in adolescent athletes with GIRD > 1
(+) impingement tests
TTP over antero- posterolateral aspect of proximal humerus –> most common sign

37
Q

what are Rx for proximal humeral apophysitis?

A

patient education
– soreness rule
– load management
– movement cues
POLICED
throwing mechanics
normalize motion - improving GIRD ratio
careful with prolonged stretching due to vulnerability of growth plate
return to play throwing progression program
MET
– cuff, trunk, scapular, LE impairments
– caution with muscle/tendons attached to growth plate

38
Q

with proximal humeral apophysitis, most return to preinjury levels as early as _______ but possibly up to ________
return to competition ________

A

2 months
2-8 months
4.5 months

39
Q

when does growth plate typically close between?

A

16-20 years

DPT MSK - fall 22 (18 decks)

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