Dislocation - Proximal Humeral Apophysitis - Exam 3 Flashcards
what joint is the most dislocated?
GH jt
what is the most common direction a dislocation happens? mechanism?
anterior - ant/inf direction
ER and ABD with FOOSH
how would a posterior dislocation happen?
90 deg flexion with FOOSH
what structures are involved with a dislocation?
stretch, tear capsule, ligament
other possible damage:
- anterior labrum tear (Bankart lesion, anterior movement of humeral head)
- SLAP lesion
compare fibrocartilage vs articular cartilage
thicker and concave
- outer portion is thick
- inner portion is thin
- widens and deepens joint surface
what locations are where fibrocartilage is a dominant tissue?
shoulder and hip labrum
SC, tibiofemoral, AC, ulnotriquetral, intervertebral, pubic symphasis
in fibrocartilage, outer collagen is primarily what type? what does it do?
type I collagen
resists tension for stabilization
majority type in ALL fibrocartilage
in fibrocartilage, inner collagen is secondarily what type? what does it do?
type II, III, IV collagen
resists compression for shock absorption
fibrocartilage is like what other structure we have learned about?
annulus –> outer type I, inner type II
the outer fibrocartilage is what kind of tissue?
vascular and neural tissue
neural attributes for proprioception/kinesthesia like ligament/annulus for stabilization
the inner fibrocartilage is what kind of tissue?
hypo- or avascular/aneural/alymphatic (resist compression)
what happens to fibrocartilage after trauma?
tears possibly with RC tear/dislocations
why is fibrocartilage better at periphery healing?
due to greater vascularity
tensile strength initially improves at _______ weeks
greater tensile strength improves when dense fibrous tissue fills in at ______ weeks
3-5 weeks
8-12 weeks
what would your MET be focused on for fibrocartilage Rx?
tissue integrity/proliferation with vascularity issues
stabilization due to stabilizing role of fibrocartilage
what other damage could occur with dislocation?
fracture aka Hill Sachs Lesion - compression fracture of humeral head
RC tears
neurovascular structures
what are symptoms of dislocation?
trauma in characteristic position
acute presentation
what would the scan findings be for dislocation?
ROM?
resisted/MMT?
stress tests?
- limited and painful most directions
- weak and painful most directions
- likely (+) depending on structure involved
what are possible (+) tests for labrum dislocation? fracture dislocation?
labrum dislocation:
anterior instability
anterior labrum
postero-inf labrum
SLAP
fracture dislocation:
olecranon-manubrium percussion test
bony apprehension test (Bankart or Hill-Sachs)
what is the main prescription for dislocations?
immobilization & POLICED
- up to 6 weeks
- improve rotator cuff activation with contralateral UE use and ipsilateral hand squeezing activities
- shorter periods are favored
What would MET focus on for dislocations?
stabilization
tissue integrity and proliferation
for an anterior dislocation, which motions should you check to be ok first? Why?
which motions are initially contra-indicated?
IR, EXT, ADD
These directions are opposite of the painful motions from a dislocation
contraindicated: ER, FLX, ABD
why would you perform isometrics and isotonics into opposite directions initially for an anterior dislocation?
start away from direction that is hurt
sensitive spindle to make aware of muscle contraction
what is the prognosis for a dislocation? recurrent dislocations are highly likely if patient is < ______ years?
not all injuries are the same so healing time is not always the same
< 30 years
what are MD Rx for dislocations?
arthroscopic vs open procedure
3-6 months prognosis
Full ROM under anesthesia
follow protocols
what is a coracoid transfer?
reposition coracoid process and coracobrachialis and short biceps head to GH neck
what is the most common MD Rx for a dislocation?
capsular shift aka capsuloraphy
overlap of torn positions of capsular folds
proximal humeral fractures are most common in? how does it happen? what structure is it most common at?
elderly
FOOSH
surgical humeral neck
what are two complications of a proximal humeral fracture?
axillary artery damage
– coldness & blanching
– emergency referral
– possible avascular necrosis
adhesive capsulitis from prolonged immobilization
what is the cause of a clavicular fracture?
compression mechanism thru long axis of clavicle at the weak spot at S curve
what are 2 complications of a clavicular fracture?
large displacement may require surgery
epiphyseal plate (growth plate) injury because it is last to ostify (18-25 years)
when would you typically start PT for a fracture?
4-8 weeks when clinical union occurs (cartilage patch turns to bony patch)
what is proximal humeral apophysitis? how is it caused?
little league shoulder - middle/high school overhead athletes (males)
UE growth plate disfunction - inflamed or separated
caused by growth with high activity
what are pathomechanics of proximal humeral apophysitis?
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
what are symptoms of proximal humeral apophysitis?
gradual onset of shoulder pain with overuse
a pop may indicate trauma and avulsion
possible loss of velocity
what would PT find with proximal humeral apophysitis?
_________ like
resisted/MMT:
special tests:
palpation:
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
what are Rx for proximal humeral apophysitis?
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
with proximal humeral apophysitis, most return to preinjury levels as early as _______ but possibly up to ________
return to competition ________
2 months
2-8 months
4.5 months
when does growth plate typically close between?
16-20 years
