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DPT 681 - MSK 1 > Labral Pathology and Shoulder Instability > Flashcards

Labral Pathology and Shoulder Instability Flashcards

1
Q

Shoulder Instability & Dislocations:

  • Classifications = ?

Labral Pathology and Shoulder Instability

A

Shoulder Instability & Dislocations - Classifications:

  • Shoulder Dislocation
  • Shoulder Instability
  • Hill-Sachs Lesion
  • Shoulder Subluxation
  • T.U.B.S & A.M.B.R.I
    • T.U.B.S = Trauma, Unidirectional, Bankart, Surgery
    • AMBRI = Atraumatic, Multidirectional, Bilateral, Rehab, Inferior
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2
Q

Shoulder Instability & Dislocations -
Characteristics:

  • Pain patterns = ?
  • Risk factors = ?
  • Observations = ?
  • Examinations = ?

Labral Pathology and Shoulder Instability

A

Shoulder Instability & Dislocations -
Characteristics:

(a) Pain Patterns:

  • Posterior shoulder pain
  • Traumatic or non-traumatic
  • Anterior shoulder pain
  • Superior shoulder pain
  • Popping
  • Clunking
  • Apprehension

(b) Risk factors:

  • Younger patients commonly under 30 y/o but older than 10 y/o
  • In women peak age is much older 61-70 y/o
  • Anterior dislocation 90%
  • Males 9-1 in younger patients
  • Females 3-1 in older adults
  • Hyper-external Rotation activities
  • Sports and Falls

(c) Observations:

  • Sulcus Sign
  • Apprehension
  • Instability (superior, Inferior, and rarely posterior directions)

(d) Examinations:

  • (+) Apprehension
  • Relocations/Surprise
  • Ant/Post Drawer
  • Load & Shift test
  • Sulcus Sign
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3
Q

Shoulder Instability & Dislocations -
Manual Therapy:

  • Joint mobilizations = ?
  • STM/MFR = ?
  • PNF = ?

Labral Pathology and Shoulder Instability

A

Shoulder Instability & Dislocations -
Manual Therapy:

(a) Joint Mobilization:

  • Hypermobility issues so joint mobs contraindicated or precaution (only Grades = I/II for pain relief).
  • Only use higher grades if patient has post immobilization loss of range of motion. Even then use cautiously.

(b) Soft Tissue Mobilization (STM) / Myofacial Release (MFR):

  • Cross Frictional Pin and Stretch to RTC, Pecs/Traps but only for healing not to increase ROM

(c) PNF:

  • PNF diagonal ROM
  • Rhythmic Stabilization
  • Multiple angle isometrics in mid ranges with humeral head control/centering
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4
Q

Shoulder Instability & Dislocations -
Therapeutic Exercise:

  • Motor = ?
  • Sensory = ?

Labral Pathology and Shoulder Instability

A

Shoulder Instability & Dislocations -
Therapeutic Exercise:

(a) Motor:

  • Humeral Head Stability
  • Avoid Flexibility/Stretching
  • Mid range RTC Strengthening endurance/reactivation
  • Isometrics, Theraband isotonics, weights, single plane progressing to multiple plane endurance but avoiding end range at first
  • Scapular Muscular Strengthening
  • All Trapezius muscles, serratus, and rhomboids for improved scapular mobility and control
  • Improved mobility of T-spine in all planes especially extension and rotation.

(b) Sensory:

  • Body blade
  • Rhythmical stabilization
  • Humeral head control to prevent A-P & Inferior migration
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5
Q

What does instability and/or dislocations sound like in a patient interview = ?

Labral Pathology and Shoulder Instability

A

What does instability and/or dislocations sound like in a patient interview:

Trauma:

  • Fall on outstretched arm, ER arm,
  • Trauma from contact posteriorly
  • Trauma from anterior direction or landing in push up position
  • Slipping/Clunking sensation
  • Inability to use the arm
  • Seen in adolescent populations, athletes, and less commonly in older adults without history of dislocation or trauma
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6
Q

At any point during elevation, only _ ? _ % of the humeral head is in contact with the glenoid.

Labral Pathology and Shoulder Instability

A

Glenoid and Dislocation:

  • At any point during elevation, only 25-30% of the humeral head is in contact with the glenoid.

Most significantly reduced when the humerus is positioned in:

  • Adduction, flexion and IR
  • Abduction and elevation
  • Adducted at the side with downwardly rotated scapula.
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7
Q

Types of Instability:

  1. = ?
  2. = ?

Labral Pathology and Shoulder Instability

A

(1) Acute /Traumatic:

  • Fall onto outstretched arm (FOOSH), fall onto adducted arm, hyper-abduction or ER.
  • Posterior dislocations can occur in football, particularly in linemen.

(2) Insidious:

  • Insidious
  • Long history of dislocations
  • Long history of significant hyperflexible
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8
Q

What ligament = ?

  • Is under maximum tension when the shoulder is fully adducted.
  • It holds up on the humeral head as we move the arm down.

Labral Pathology and Shoulder Instability

A

Superior GH ligament

  • Is under maximum tension when the shoulder is fully adducted.
  • It holds up on the humeral head as we move the arm down.

Glenohumeral Joint Ligaments: Primary Restraint Against Anterior and Posterior Dislocation

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9
Q

What ligament = ?

  • Is under maximum tension at 45 deg abduction.

Labral Pathology and Shoulder Instability

A

Middle GH Ligament

  • Is under maximum tension at 45 deg abduction and external rotation (limits external rotation).

Glenohumeral Joint Ligaments: Primary Restraint Against Anterior and Posterior Dislocation

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10
Q

What ligament = ?

  • Comprised of three different parts: an anterior band, posterior band and axillary pouch.

Labral Pathology and Shoulder Instability

A

Inferior GH Ligament

  • Comprised of three different parts: an anterior band, posterior band and axillary pouch.
  • Anterior band is under tension when the shoulder is extended, Abduction to 90 and external rotation.

Glenohumeral Joint Ligaments: Primary Restraint Against Anterior and Posterior Dislocation

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11
Q

Static stabilization in shoulder comes from = ?

Labral Pathology and Shoulder Instability

A

Static stabilization in shoulder comes from:

  • Joint capsule
  • Joint cohesion (minimal in shoulder)
  • Ligamentous support (reinforcements/thickenings of the capsule)
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12
Q

Dislocation and stability test are utilized to detect dislocations/subluxations or the tendency towards laxity, and

  • TUBS = ?
  • AMBRI = ?

Labral Pathology and Shoulder Instability

A

(-)
Dislocation and stability test are utilized to detect dislocations/subluxations or the tendency towards laxity, and

(a) TUBS

  • Traumatic
  • Unilateral
  • Bankart
  • Surgery required

(b) AMBRI

  • Atraumatic
  • Multidirectional instability
  • Bilateral
  • Rehab is suggested, Inferior capsular shift requires surgery)

(-)
Realize that while these conditions typically have some type of capsular involvement, they can often occur at the same time as labral injuries or even rotator cuff injuries so lots of these test may also be positive with or for a labral tear.

(-)
Younger dislocations typically need surgery. Older adults can typically rehab unless the instability happens repeatedly.

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13
Q

Tests for Anterior Shoulder Instability = ?

Labral Pathology and Shoulder Instability

A

Tests for Anterior Shoulder Instability:

  • Apprehension (Crank) test for anterior shoulder dislocation
  • Modified Relocation/Surprise test:
  • Anterior Drawer
  • Load and shift test
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14
Q

Tests for Posterior Shoulder Instability = ?

Labral Pathology and Shoulder Instability

A

Tests for Posterior Shoulder Instability:

  • Jerk test
  • Posterior drawer test of shoulder
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15
Q

Tests for Inferior Shoulder Instability = ?

Labral Pathology and Shoulder Instability

A

Tests for Inferior Shoulder Instability

  • Sulcus sign
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16
Q

Apprehension Test
(Fulcrum Test)

Labral Pathology and Shoulder Instability

A

Apprehension Test / Fulcrum Test:

  • The patient is either standing or supine.
  • The examiner stands either behind or at the involved side of the patient.
  • The examiner grasps the wrist with one hand and maximally externally rotates the humerus with the shoulder in 90 degrees of abduction.
  • Forward pressure is then applied to the posterior aspect of the humeral head by either the examiner (if patient is standing) or the examination table (if the patient is in supine).
  • Positive Test for anterior instability is indicated by a show of apprehension by the patient or a report of pain.

Video

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17
Q

Modified Relocation / Surprise Test

Labral Pathology and Shoulder Instability

A

Modified Relocation / Surprise Test:

  • The patient assumes a supine position.
  • The examiner stands beside the patient.
  • The examiner pre-positions the shoulder at 120 degrees of abduction then grasps the patient’s forearm and maximally externally rotates the humerus.
  • A posterior to anterior force is then applied to the posterior aspect of the humeral head by the examiner.
  • If the patient reports pain, a posterior force is then applied to the proximal humerus.
  • Positive Test for labral pathology is indicated by a report of pain with the anterior-directed force and relief of pain with the posterior-directed force.
  • Suprise Test: Suddenly let go of the relocation and patient gets a sudden return of apprehension.

Note f/PowerPoint:

  • Realize this is basically the same test as your apprehension test you are just reducing the potential instability after it occurs for the modified relocation test and then suddenly letting that relocation go for the surprise test.

Surprise Test:

  • SN = 81-90
  • If negative, helps rule out anterior instability.

Apprehension/Relocation:

  • SN = 92-64
  • Specificity = 84-99
  • Positive (+) LR = 5.42
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18
Q

Load and Shift Test (Anterior and Posterior) = ?

Labral Pathology and Shoulder Instability

A

Load and Shift Test (Anterior and Posterior):

  • The patient assumes a supine or standing position.
  • The examiner stands to the side of the patient’s involved shoulder.
  • The examiner grasps the proximal humerus with one hand providing a compression force and “loading” the humerus into the glenoid fossa.
  • The examiner’s other hand stabilizes the scapula.
  • The examiner applies an anterior-to-posterior force noting the amount of translation as either:

(1) to the posterior rim of the glenoid,

(2) beyond the rim of the glenoid.

  • The examiner applies a posterior-to-anterior force noting the amount of translation as either:

(1) to the anterior rim of the glenoid

(2) beyond the rim of the glenoid

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19
Q

Sulcus Test = ?

Labral Pathology and Shoulder Instability

A

Sulcus Test (Inferior Shoulder Instability):

  • The patient assumes a sitting position. The examiner stands behind the patient.
  • The examiner grasps the elbow and pulls down causing an inferior traction force.
  • The examiner notes, in centimeters, the distance between the inferior surface of the acromion and the superior portion of the humeral head.

CR Video

SN = 17

SP = 93

Positive (+) LR = 2.4

Negative (−) LR = 0.89

QUADAS = 10

20
Q

Diagnostic Cluster(s) for instability = ?

Labral Pathology and Shoulder Instability

A

Diagnostic Cluster(s) for Instability Test:

(1) Malhi & Khan

  • Apprehension or Relocation

Stats:

  • SN = 81
  • SP = 1.0
  • Positive (+) LR = NA
  • Negative (-) LR = 19.0
  • QUADAS (0-14) = 5

(2) Lei et al.

  • Apprehension, and
  • Relocation, and
  • Suprise

Stats:

  • SN = 40
  • SP = 100
  • Positive (+) LR = NA
  • Negative (-) LR = NA
  • QUADAS (0-14) = 7

(3) Farber et al.

  • Apprension, and
  • Relocation

Stats:

  • SN = 81
  • SP = 98
  • Positive (+) LR = 36.98
  • Negative (-) LR = 0.19
  • QUADAS (0-14) = 11
21
Q

Labral Pathologies:

  • Classifications = ?

Labral Pathology and Shoulder Instability

A

Labral Pathologies - Classifications:

  • Labral Tear
  • Bankart Lesion
  • SLAP Tear/SLAP Lesion: Superior Labral Tear extending Anterior to
  • Posterior
  • Micro instability
  • Peel back lesion
22
Q

Labral Pathologies - Characteristics:

  • Pain Patterns = ?
  • Risk Factors = ?
  • Observations = ?
  • Examination = ?

Labral Pathology and Shoulder Instability

A

Labral Pathologies - Characteristics:

(a) Pain Patterns:

  • Deep shoulder pain
  • Traumatic or non-traumatic labral tears
  • Popping, clunking, subluxation
  • Apprehension
  • Dead Arm

(b) Risk Factors:

  • Younger patients under 40 Years Old
  • Hyper-external rotation activities such as a fall on outstretch arm.
  • Increase in UE activities (Swimming, softball, baseball, wrestling)

(c) Observations:

  • Loss of velocity with throwing activities
  • Popping, clicking, clunks in shoulder
  • Apprehension less common

(d) Examination:

  • (+) Passive Distraction
  • Dynamic Labral Shear
  • Biceps Load II
  • Crank/Clunk test
  • O’Brien’s
  • Jerk Test
  • Anterior Slide test
23
Q

Labral Pathologies - Manual Therapy:

  • Joint Mobilization = ?
  • STM/MFR = ?
  • PNF = ?

Labral Pathology and Shoulder Instability

A

Labral Pathologies - Manual Therapy:

(a) Joint Mobilization:

  • Traditional joint mobilizations would not be appropriate for most instability/labral patients.
  • Hypermobility issues so only Grades = I/II for pain relief

(b) STM/MFR:

  • Cross Frictional Pin and Stretch to RTC,
  • Pecs/Traps but only for healing not to increase ROM

(c) PNF:

  • PNF diagonal ROM
  • Rhythmic Stabilization (Best option)
  • Multiple angle isometrics with humeral head control/centering
24
Q

Labral Pathologies - Therapeutic Exercise:

  • Motor = ?
  • Sensory = ?

Labral Pathology and Shoulder Instability

A

Labral Pathologies - Therapeutic Exercise:

(a) Motor:

  • Humeral Head Stability
  • Avoid flexibility/stretching at end ranges of motion.
  • Mid range RTC strengthening endurance/reactivation.
  • Isometrics, theraband isotonics, weights, single plane progressing to multiple plane endurance but avoiding end range during early rehab.
  • Scapular Muscular Strengthening (all trapezius muscles, serratus, and rhomboids for improved scapular mobility and control).
  • Improved mobility of T-spine in all planes especially extension and rotation.

(b) Sensory:

  • Body blade
  • Rhythmical stabilization
  • Humeral head control to prevent A-P & Inferior migration
25
Q

What do Labral dysfunctions sound like in a patient interview = ?

Labral Pathology and Shoulder Instability

A

What do Labral Dysfunctions sound like in a patient interview?

  • Popping
  • Clunking
  • “Dead Arm” with loss of velocity in overhead athletes
  • Slipping
  • Looseness
  • Instability
  • Catching in the arm
  • Seen in adolescent populations, athletes
26
Q

Three important facts about anatomy of the labrum important = ?

Labral Pathology and Shoulder Instability

A
  • Glenoid fossa is made about 50% deeper by the labrum
  • Labrum attaches to the glenoid cavity, joint capsule and lateral portion of the biceps.
  • Increases compression of Humeral Head to Glenoid (pressurizes the joint)
  • Labrum said to act like a chalk block
  • Approximately 50% of the fibers of the long head of the biceps brachii originate from the superior labrum and the remaining fibers originate from the supraglenoid tubercle of the glenoid
27
Q

Two types of Labral tears = ?

Labral Pathology and Shoulder Instability

A

Types of Labral Tears:

(1) SLAP:

  • Located from 10 o’clock to 2 o’clock)
  • Eccentric action of biceps during late throwing phase can place high stress on top of labrum (SLAP/bicep pathology).
  • “Peel Back Mechanism” with Hyper-external Rotation/Abd (Cocking phase of throwing).
  • Substantial instability present with SLAP tear; up to 6 mm increase in anterior translation.

(2) Bankart:

  • Located from 3 o’clock to 6 o’clock.
  • Anterior glenohumeral dislocation due to posteriorly directed force, producing anteroinferior displacement of humeral head with resulting impact of proximal humerus on anteroinferior glenoid rim.
  • Small glenoid rim fracture is often produced along with a Hills-Sach lesion (impaction fracture of the posterolateral humeral head).
28
Q

SLAP Lesion:

  • Diagnosis = ?

Labral Pathology and Shoulder Instability

A

SLAP Lesion - Diagnosis:

SLAP lesion (superior labral, anterior-posterior lesion) Classifications:

  • Type 1: Superior labrum markedly frayed but attachments intact.
  • Type 2: Superior labrum has a small tear and there is instability of the labral-biceps complex (MC).
  • Type 3: Buclket-handle tear of labrum may displace into joint; labral biceps attachment intact.
  • Type 4: Bucket-handle tear of labrum that extends to biceps tendon, allowing tendon to sublux into joint.
29
Q

SLAP Lesion:

  • Prevalence = ?

Labral Pathology and Shoulder Instability

A

SLAP Lesion - Prevalence:

  • MC in male - 91% (ave. age 38)
  • Dominant arm 2 time more likely to be involved.
  • Can be due to superior compression or inferior traction.
  • Often occurs from falling on outstretched hand.
  • Occurs in throwing athletes, associated with the follow through.

Common in Type 2

  • Repetitive overhead activities, commonly a direct blow to the shoulder
  • Higher incidence in occupations requiring heavy lifting.
  • No specific cause with insidious onset 22%.
30
Q

SLAP Lesion:

  • Symptoms = ?

Labral Pathology and Shoulder Instability

A

SLAP Lesion - Symptoms:

31
Q

SLAP Lesion:

  • DSM/Signs = ?

Labral Pathology and Shoulder Instability

A

SLAP Lesion - DSM/Signs:

32
Q

SLAP Lesion:

  • TBC/Special Tests = ?

Labral Pathology and Shoulder Instability

A

SLAP Lesion - TBC/Special Tests:

*

33
Q

Tests for Labral Tears = ?

Labral Pathology and Shoulder Instability

A

Tests for Labral Tears:

  • Jerk Test
  • Passive Compression Test/Passive Distraction Test
  • Modified Dynamic Labral Sheer Test
  • Biceps Load Test I/II
  • O’Brien’s Active Compression Test
  • Anterior Slide Test
  • Crank and Clunk test
  • Resisted Supination External Rotation Test - (Latest Systematic Review indicates poor sensitivity for most of the SLAP TEST so negative test don’t allow you to completely rule out this pathology. Compression and Passive Distraction look better than the others at this point.)
34
Q

Jerk Test = ?

Labral Pathology and Shoulder Instability

A

Jerk Test (Posterior Labrum):

  • The patient assumes a sitting position.
  • The examiner stands behind the patient.
  • The examiner grasps the elbow with one hand and the scapula with the other and elevates the patient’s arm to 90 degrees abduction and internal rotation.
  • The examiner provides an axial compression-based load to the humerus through the elbow maintaining the horizontally abducted arm.
  • The axial compression is maintained as the patient’s arm is moved into horizontal adduction/horizontal flexion.
  • Positive Test is indicated by a sharp shoulder pain with or without a clunk, shift, or click.
  • This clunk/click/shift causes the arm to “jerk” suddenly which is where the name of this test comes from.

SN = 73 (NR)

SP = 98 (NR)

Positive (+) LR = 34.7

Negative (−) LR = 0.27

QUADAS = 11

CR Video

35
Q

Modified Dynamic Labral Shear Test = ?

Labral Pathology and Shoulder Instability

A

Modified Dynamic Labral Shear Test:

SN = 72
SP = 98

CR Video

36
Q

Biceps Load Test I & II = ?

Labral Pathology and Shoulder Instability

A

Biceps Load Test I & II (Superior labrum):

  • The patient assumes a supine position.
  • The examiner sits on the side of the patient’s involved extremity.
  • The examiner places the patient’s shoulder in either 90 or 120 degrees of abduction, the elbow in 90 degrees of flexion, and the forearm in supination.
  • The examiner moves the patient’s shoulder to end-range external rotation (apprehension position).
  • At end-range external rotation, the examiner asks the patient to flex his or her elbow while the examiner resists this movement.
  • Positive Test is indicated as a reproduction of concordant pain during resisted elbow flexion.

SN = 90 (NR)
SP = 97 (NR)
Positive (+) LR = 30.3
Negative (-) LR = 0.11
QUADAS = 11

37
Q

O’Brien’s Active Compression Test = ?

Labral Pathology and Shoulder Instability

A

O’Brien’s Active Compression Test:

To test for the presence of a labral tear or pathology of the acromioclavicular joint.

  • Sitting with shoulder at 90 degrees, slight horizontal adduction and internal rotation.
  • Standing to the side of the patient Resist elevation with arm in internal rotation followed by resistance with arm in external rotation.
  • Positive Test if there is pain and weakness experienced on resistance with the arm in internal rotation that exceeds the pain and weakness noted in external rotation, suggesting a labral tear or acromioclavicular joint pathology.

SN = 94
SP = 28

38
Q

Passive Distraction Test = ?

Labral Pathology and Shoulder Instability

A

Passive Distraction Test:

SN = 53 (NR)
SP = 94 (NR)
Positive (+) LR = 8.8
Negative (-) LR = 0.5
QUADAS = 8

39
Q

Labral Crank Test = ?

Labral Pathology and Shoulder Instability

A

Labral Crank Test:

  • The patient assumes either a sitting or supine position.
  • The examiner typically stands at the side of the involved extremity.
  • The examiner places the patient’s shoulder in 160 degrees of abduction and elbow in 90 degrees of flexion.
  • The examiner first applies a compression force to the humerus and then rotates the humerus repeatedly into internal rotation and external rotation in an attempt to pinch the torn labrum.
  • Positive Test is indicated by the production of pain either with or without a click in the shoulder or by reproduction of the patient’s concordant complaint (usually pain or catching).

SN = .34 - .57
SP = .72- .77

CR Video

40
Q

Treatment for labrum and instability = ?

Labral Pathology and Shoulder Instability

A

Treatment For Labrum and Instability:

  • Teach shoulder centering
  • Focus on shoulder stabilization exercises that avoid excessive end range positions
  • Increase muscular strength to help compensate for lack of ligamentous & capsular control
  • Lots of scapular work
  • Equalize muscle balance but avoid lots of stretching or excessive joint mobilizations.
  • For overhead athletes, strongly emphasis proper mechanics (i.e. use of thorax and pelvic girdle/hips).
  • Focus on core and gluteal strengthening in throwing athletes, along with dynamic balance tasks.
  • Mid-range movements
41
Q

Rhythmic stabilization and rhythmic initiation for treatment of labrum and instability = ?

Labral Pathology and Shoulder Instability

A

Rhythmic stabilization for treatment of labrum and instability:

  • Begin supine with elbow flexed in open pack position.
  • Progress to 90 degrees flexion and scapular protraction.
  • Apply perturbations in all directions.
  • Progress by increasing force, holding a weighted ball, moving towards closed chain.

Rhythmic Initiation:

  • Rhythmic motion of the limb through the desired range, starting with passive motion and progressing to active resisted motion.
  • Beneficial to improve ER/IR strength with a strong emphasis on humeral head centering for patients with GH instability.
42
Q

Examples of stability exercises include = ?

Labral Pathology and Shoulder Instability

A

Stability exercises:

(a) Close Chain Scapular clocks, with humeral head depression and scapular control.

(b) Rebounder:

  • Catch and throw with centered shoulders.

(c) Wall Dribbles:

  • Start by bouncing/pressing the ball along the wall until it is overhead and return to starting position.
  • Keep ball bouncing through the entire pattern. Elbow can remains straight throughout motion or have a set level of flexion.
43
Q

Manual Therapy Interventions for Labral Pathologies:

  • Benefits and how to perform cross friction massage = ?

Labral Pathology and Shoulder Instability

A

Manual Therapy Interventions for Labral Pathologies:

(a) Initially proposed by Cyriax to enable to following:

  • Induces microtraumatic hyperemia
  • Movement of the affected structure (see chart), which prevents or removes adhesions and optimizes the quality of the scar tissue.
  • Stimulation of mechanoreceptors, which stimulate a temporary analgesia.

(b) Principles of cross friction:

  • Apply force perpendicular to the tendon until analgesia is attained.
  • Reinforce your pointer finder with your middle finger.
  • Create force by moving your entire UE, not just the finger/hand. This will reduce fatigue and protect your hand
44
Q

The recoginition and treatment of superior labral (SLAP) lesions in the oberhead athlete = ?

Labral Pathology and Shoulder Instability

A

The recoginition and treatment of superior labral (SLAP) lesions in the oberhead athlete:

  • For patients who sustained a SLAP lesion via a compressive injury, such as a fall on an outstretched hand, weight‐bearing exercises should be avoided to minimize compression and sheer on the superior labrum.
  • Patients with traction injuries should avoid heavy resisted or excessive eccentric biceps contractions.
  • Patients with peel‐back lesions, such as overhead athletes, should avoid excessive amounts of shoulder external rotation while the SLAP lesion is healing.
  • Thus the mechanism of injury is an important factor to individually assess when determining appropriate rehabilitation guidelines for each patient.
45
Q

Take Home Message about Shoulder Instability = ?

Flip and Review

Labral Pathology and Shoulder Instability

A

Take Home Message about Shoulder Instability:

  • Can we train the musculature to support the compromised joint better?
  • Can we retrain throwing motions to utilize core better and utilize legs better with reduced arm stress?
  • Do asymmetries and imbalances make the instability more problematic?
  • Neuromuscular control is our main focus with strength a close second.

DPT 681 - MSK 1 (17 decks)

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