GH Instability - Management Flashcards
non-operative goals
protect against recurrent dislocation
improve dynamic stability
protect against recurrent dislocation –> non-operative goals
closed reduction
immobilization in slight w/ shoulder positioned in ADD and IR for 3-6 weeks
pt education
activity modification
improve dynamic stability –>non-operative goals
RC and scap stabilizers
strength
endurance
non-surgical management phases
1 - acute
2 - subacute
3
4
phase 1 goals –> non-surgical
decrease pain/inflammation
allow capsular healing
minimize muscle disuse atrophy
restore full ROM
phase 1 tx –> non-surgical
modalities and joint mobs to decrease pain/inflammation
mobilizations/ROM/AAROM exercise to restore mobility
submax, pain free isometrics
pt education
mobilizations/ROM/AAROM exercise to restore mobility –> phase 1 tx
grades 1&2
submax, painfree isometrics –> phase 1 tx
safest directions are IR and ADD
phase 2 goals –> non-operative
improve dynamic stabilization
phase 2 tx–> non-operative
isotonic cuff strengthening
scapula strengthening
shoulder musculature strengthening
introduce CKC exercises
PNF rhythmic stabilization to promote muscle co-contraction
phase 3
advances strengthening
progressive strengthening upper quarter
progression of tx
position
resistance
mode
endurance
plyometrics
position –> progression
scapular plane
90/90 position
resistance –> progression
isometric/isotonic
theraband
free weight
mode –> progression
concentric
eccentric
isokinetics
phase 4 –> non-operative
return to move rigorous activity or sport
goal –> phase 4
unrestricted sxs free activity
what may someone in phase 4 need
shoulder orthotic
SAWA or Sulley brace to restrict end ranges of motion during activity
indications for surgical management
traumatic or atraumatic
traumatic –> indications for surgical management
< 30 yo
multiple episodes
atraumatic –> indications for surgical management
failed conservative management
recurrent GH subluxation or dislocation
surgical procedures
arthroscopic capsular plication
inferior capsular shift
anterior capsulolateral repair
bankart repair
capsular shift procedures
arthroscopic capsular plication
if a labral tear is present
arthroscopic capsular plication
creates a fold in capsular tissue to remove unwanted redundancy
suture to intact labrum
if a labral tear is present –> capsular shift procedures
anchors places into glenoid to repair labral tear
sutures tighten capsule back to labrum
goal of bankart repair
reconnect torn labrum to glenoid fossa
what does a bankart repair restore
tension to anteroinferior capsule and AIGHL
procedure –> bankart repair
sutures through glenoid and capsulolabral tissue to anatomically repair labrum back to glenoid rim
goal of phase 1 –> surgical
promote tissue healing
control pain and inflammation
gradual increase in ROM
independent HEP
initiate muscle contraction
precautions phase 1 –> surgical
no active ER, ABD or extension
goals of phase 2 –> surgical
control pain and inflammation
increase UE strenght
gradual increase ROM
goal phase 3 –> surgical
minimize pain
swelling
full ROM
improved UE strength and endurance
enhance NM control
normalize arthrokinematics
strength –> phase 3 –> surgical
initiate overhead plyotoss at weeks 8-10
tubing ER exercise at 90 degrees ABD
UBE for strength/endurance
progressing rhythmic stabilization including standing PNF patterns w/ tubing
