GH Instability - Management

Question 1

non-operative goals

Answer 1

protect against recurrent dislocation

improve dynamic stability

Question 2

protect against recurrent dislocation –> non-operative goals

Answer 2

closed reduction

immobilization in slight w/ shoulder positioned in ADD and IR for 3-6 weeks

pt education

activity modification

Question 3

improve dynamic stability –>non-operative goals

Answer 3

RC and scap stabilizers

strength

endurance

Question 4

non-surgical management phases

Answer 4

1 - acute

2 - subacute

3

4

Question 5

phase 1 goals –> non-surgical

Answer 5

decrease pain/inflammation

allow capsular healing

minimize muscle disuse atrophy

restore full ROM

Question 6

phase 1 tx –> non-surgical

Answer 6

modalities and joint mobs to decrease pain/inflammation

mobilizations/ROM/AAROM exercise to restore mobility

submax, pain free isometrics

pt education

Question 7

mobilizations/ROM/AAROM exercise to restore mobility –> phase 1 tx

Answer 7

grades 1&2

Question 8

submax, painfree isometrics –> phase 1 tx

Answer 8

safest directions are IR and ADD

Question 9

phase 2 goals –> non-operative

Answer 9

improve dynamic stabilization

Question 10

phase 2 tx–> non-operative

Answer 10

isotonic cuff strengthening

scapula strengthening

shoulder musculature strengthening

introduce CKC exercises

PNF rhythmic stabilization to promote muscle co-contraction

Question 11

phase 3

Answer 11

advances strengthening

progressive strengthening upper quarter

Question 12

progression of tx

Answer 12

position

resistance

mode

endurance

plyometrics

Question 13

position –> progression

Answer 13

scapular plane

90/90 position

Question 14

resistance –> progression

Answer 14

isometric/isotonic

theraband

free weight

Question 15

mode –> progression

Answer 15

concentric

eccentric

isokinetics

Question 16

phase 4 –> non-operative

Answer 16

return to move rigorous activity or sport

Question 17

goal –> phase 4

Answer 17

unrestricted sxs free activity

Question 18

what may someone in phase 4 need

Answer 18

shoulder orthotic

SAWA or Sulley brace to restrict end ranges of motion during activity

Question 19

indications for surgical management

Answer 19

traumatic or atraumatic

Question 20

traumatic –> indications for surgical management

Answer 20

< 30 yo

multiple episodes

Question 21

atraumatic –> indications for surgical management

Answer 21

failed conservative management

recurrent GH subluxation or dislocation

Question 22

surgical procedures

Answer 22

arthroscopic capsular plication

inferior capsular shift

anterior capsulolateral repair

bankart repair

Question 23

capsular shift procedures

Answer 23

arthroscopic capsular plication

if a labral tear is present

Question 24

arthroscopic capsular plication

Answer 24

creates a fold in capsular tissue to remove unwanted redundancy

suture to intact labrum

Question 25

if a labral tear is present –> capsular shift procedures

Answer 25

anchors places into glenoid to repair labral tear

sutures tighten capsule back to labrum

Question 26

goal of bankart repair

Answer 26

reconnect torn labrum to glenoid fossa

Question 27

what does a bankart repair restore

Answer 27

tension to anteroinferior capsule and AIGHL

Question 28

procedure –> bankart repair

Answer 28

sutures through glenoid and capsulolabral tissue to anatomically repair labrum back to glenoid rim

Question 29

goal of phase 1 –> surgical

Answer 29

promote tissue healing

control pain and inflammation

gradual increase in ROM

independent HEP

initiate muscle contraction

Question 30

precautions phase 1 –> surgical

Answer 30

no active ER, ABD or extension

Question 31

goals of phase 2 –> surgical

Answer 31

control pain and inflammation

increase UE strenght

gradual increase ROM

Question 32

goal phase 3 –> surgical

Answer 32

minimize pain

swelling

full ROM

improved UE strength and endurance

enhance NM control

normalize arthrokinematics

Question 33

strength –> phase 3 –> surgical

Answer 33

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