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NYCC Extremities Tech II > GH Dislocation & Instability > Flashcards

GH Dislocation & Instability Flashcards

1
Q

What structures and mechanisms act as passive stabilizers of the GH joint?

A

Superior, middle, and inferior GH ligaments and joint capsule
Glenoid labrum
Negative intra-articular pressure (Vacuum effect)

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2
Q

What anatomical structure provides stability to a joint at the extreme ranges of motion?

A

Ligaments

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3
Q

Ligaments provide stability to a joint at the ____ ranges of motion in the glenohumeral joint?

A

Extreme

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4
Q

What is the function of the glenoid labrum?

A

Increases depth and contact area of the glenoid fossa

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5
Q

What is glenohumeral instability?

A

Excessive symptomatic displacement of the humeral head in the glenoid fossa

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6
Q

What are the three types of GH instability?

A

Dislocation
Medical subluxation
Microinstability

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7
Q

What is the most common cause of GH instability?

A

Trauma

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8
Q

What are the major causes of GH instability?

A

Trauma
Congenital ligament laxity

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9
Q

Trauma results in ____ instability of joints?

A

Uni-directional

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10
Q

What is uni-directional instability?

A

Instability of the joint in the direction of the trauma

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11
Q

Uni-directional instability occurs in the (Same/Opposite) direction of the trauma?

A

Same

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12
Q

What are the grades of joint instability from stable to the worst scenario?

A

Stable ——> Microinstability ——> Subluxation ——> Dislocation

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13
Q

What is a common cause(s) of congenital ligament laxity?

A

Connective tissue disorder such as Ehler’s Danlos and Marfan’s syndrome

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14
Q

Congenital ligament laxity results in ____ instability

A

Multi-directional

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15
Q

What is a glenohumeral dislocation?

A

When the humeral head slips out of the glenoid fossa

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16
Q

What is the most common direction of dislocation of the GH joint?

A

Anterior-inferior

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17
Q

What is the major or most common cause of first time GH dislocation?

A

Trauma

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18
Q

What are two mechanisms for how an anterior-inferior GH joint dislocation occurs?

A

Combination of forced ABduction, Extension, and External Rotation
P-A blow to posterior shoulder

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19
Q

What is the most common mechanism for an anterior-inferior GH joint dislocation?

A

Combination of forced ABduction, Extension, and External Rotation

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20
Q

What is GH joint instability?

A

Excessive SYMPTOMATIC displacement of the humeral head in the glenoid fossa

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21
Q

What tissues are commonly injured in an anterior-inferior GH dislocation?

A

Anterior aspect of the Inferior GH ligament
Anterior-inferior labrum
RC muscles

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22
Q

How will a patient present to your office if they suffer an acute anterior-inferior GH dislocation?

A

Arm held slightly ABducted and supported by other arm with intense pain

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23
Q

If it seems obvious that a patient has a GH dislocation you must perform orthopedic testing to confirm your diagnosis (TRUE/FALSE)?

A
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24
Q

How will a patient present upon physical examination of the area surrounding an anterior-inferior GH joint dislocation?

A

Sharp deltoid contour
Prominent acromion
Palpable fullness below coracoid process

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25
Q

For neurovascular testing of a patient with a GH joint dislocation, you must perform both pre and post reduction exams (TRUE/FALSE)?

A

t

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26
Q

What artery must be checked for a patient with an anterior-inferior GH dislocation?

A

Axillary artery

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27
Q

What rotator cuff muscle is most commonly torn in an anterior-inferior GJ dislocation?

A

Subscapularis

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28
Q

What is the most frequently injured nerve in an anterior-inferior GJ joint dislocation?

A

Axillary nerve

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29
Q

What is the purpose of a radiograph for a patient with a GJ joint dislocation?

A

Rule out fracture and confirm direction of dislocation

30
Q

What is a Hill-Sacks lesion?

A

Posterior humeral head fracture

31
Q

What is a Bankart lesion?

A

Anterior-inferior rim of glenoid fossa fracture

32
Q

Reduction of a first time dislocation is controversial without X-rays (TRUE/FALSE)?

A

t

33
Q

Reduction of a RECURRENT dislocation is not very controversial without X-rays (TRUE/FALSE)?

A

t

34
Q

In a young athlete, an athletic trainer will reduce a shoulder dislocation immediately on the spot if trauma is known (TRUE/FALSE)?

A

t

35
Q

What are the most common fractures of the humeral head during a dislocation?

A

Greater tuberosity
Posterior humeral head (Hill-Sacks)
Anterior-inferior rim of glenoid fossa (Bankart)

36
Q

Why is an immediate reduction often done on athletes?

A

Because waiting too long allows the muscles to spasm up and makes reducing harder without sedation

37
Q

If a doctor chooses not to immediately reduce a dislocation and the patient is sent to the emergency room, what will likely be required in order to reduce this persons shoulder?

A

Sedation to reduce pain and spasm

38
Q

Under the current scope of practice, chiropractors are able to perform closed reductions of a shoulder dislocation in the US (TRUE/FALSE)?

A
39
Q

What is the standard of care after a closed reduction for a first time dislocation?

A

4-6 weeks of immobilization only removing the arm for treatment

40
Q

What is the recommended treatment for a 1st time shoulder dislocation in a young active person after reduction?

A

Surgery

41
Q

What is the recommended treatment for a shoulder dislocation in an older individual?

A

Conservative treatment

42
Q

Patients under 25 have a (Low/High) chance of re-dislocation if non-surgical treatment is opted for?

A

High

43
Q

Older individuals over 45 have a (Low/High) chance of re-dislocation if non-surgical treatment is opted for?

A

Low

44
Q

What are examples of closed reduction techniques for an anterior-inferior dislocation?

A

Milch
Hippocratic
Traction-Counter Traction
Stimson
Kocher

45
Q

What is implicated in an open reduction of the shoulder?

A

Surgery

46
Q

What is a medical subluxation of the GH joint?

A

Humeral head moves to the edge but does NOT leave the glenoid fossa

47
Q

What is the most common direction of a GH joint subluxation?

A

Anterior-inferior

48
Q

What are the two major causes of a medical subluxation of the GH joint?

A

Acute trauma
Chronic repetitive trauma

49
Q

What is the most common mechanism of injury for a medical subluxation of the GH joint?

A

Combination of forced ABduction, Extension, and External Rotation

50
Q

What is an apprehension test for the shoulder?

A

Test for anterior instability of the GH joint that may indicate a medical subluxation. Performed by bracing the arm and slowly moving it into external rotation

51
Q

What should be tested for on a physical exam of a patient with a suspected GH joint subluxation?

A

Generalized ligament laxity

52
Q

What is an example of a test for assessing generalized GH joint ligament laxity and hypermobility?

A

Beighton Score

53
Q

What is a Beighton Score?

A

Assessment of joint HYPERmobility scored from 0-9 with one point allocated for each of the tests performed

54
Q

What is a positive Beighton Score for an adult?

A

37020

55
Q

Joint mobilization is the only answer for GH joint instability (TRUE/FALSE)?

A
56
Q

A low-grade mobilization DOES NOT stress tissues (TRUE/FALSE)?

A

t

57
Q

What is a positive Beighton Score for a child?

A

37051

58
Q

What may be evident in a patient’s history if they have a medical subluxation of the GH joint?

A

Pain
Unstable sensation
Hx of prior dislocation

59
Q

During an anterior inferior dislocation of the GH joint what two PASSIVE structures are frequently injured and play a major role in allowing recurrent dislocations or subluxations?

A. Middle GH ligament
B. Anterior aspect of the inferior glenohumeral ligament
C. Inferior aspect of the infraspinatus
D. Anterior-inferior aspect of the GH labrum

A

B and D

60
Q

What is microinstability of the GH joint?

A

A subtle form of instability that is usually only seen in athletes involved in intense repetitive overhead sports

61
Q

What is the most common direction if microinstability in the GH joint?

A

Anterior-inferior

62
Q

What is the major cause of microinstability of the GH joint?

A

Chronic repetitive trauma

63
Q

What is the mechanism of injury of microinstability of the GH joint?

A

Combination of forced ABduction, Extension, and External Rotation

64
Q

When does a patient experience symptoms with GH microinstability?

A

Extreme repetitive demands usually during a sporting activity

65
Q

You should NOT mobilize or manipulate a joint into the direction of instability (TRUE/FALSE)?

A

t

66
Q

What type of mobilization is good for early treatment of anterior-inferior GH joint instability?

A

Low grade lateral distraction mobilizations

67
Q

What are the objectives of low grade lateral distraction mobilizations for anterior-inferior GH joint instability?

A

Decrease pain
Move synovial fluid
Maintain joint play

68
Q

What type of mobilization can be used in later stages of an anterior-Inferior GH joint instability?

A

A-P glide to treat a tight posterior capsule

69
Q

What mobilizations should NOT be used for an anterior-inferior GH joint instability issue?

A

P-A glides and external rotation with ABduction (You’re pushing the thing out of place)

70
Q

With a tight posterior capsule in the GH joint, the humeral head translates ____

A

Anterior and superior

NYCC Extremities Tech II (7 decks)

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