Sh. dislocations

Question 1

Anterior sh. dislocation AKA traumatic unidirectional instability (TUBS) Pathology

Answer 1

TUBS: Lax connective tissue usually results of trauma in one direction (anterior, posterior, inferior) there may be damage to the RC tendon and ligaments.

Question 2

Clinical Signs

Answer 2

Fx. limitations: inability to reach or lift at sh. level.
Restricted ability in many ADL’s and leisure activities.
Pain when sleeping.

Question 3

Interventions (4-8 weeks)

Answer 3

After reduction the arm is immobilized and in a sling for 3 weeks. Elbow distally needs to get ex. strike zone movements (below waist to chest height)
Strengthening: IR/ER and ADD need to be strong to support the anterior capsule. ER needs to be strong to cause humeral depression.
Begin w/ isometric ex. w/ joint at side (pain free)
Progress to isotonic ex. still limiting ER to less then 50. Therband for constant tension: IR/ER, ADD and biceps in subpingment range w/ light resistance. Do ER from full IR to neutral w/ arm at side no 90 of ABD.
At 5 weeks: all pivots except 90 of ABD and ER.
Normal use when there is no weakness may take 2-4 months.

Question 4

Sh. dislocation precautions

Answer 4

No PROM, ER w/ ABD and hyber extension.

Do not ER w/ arm at side only to 50 degrees.