Shoulder Flashcards
what is shoulder instability?
abnormal and symptomatic movement of the humeral head across the glenoid fossa
what is the stanmore triangle?
a way of grouping causes of shoulder instability, often patients are in between groups.
Polar type 1- traumatic structural
Polar type 2- atraumatic structural
Polar type 3- muscle patterning non structural
what is polar type I on the stanmore triangle?
traumatic structural
what is polar type II on the stanmore triangle?
Atraumatic structural
what is polar type III on the stanmore triangle?
muscle patterning non structural
what are the features of polar type I on the stanmore triangle?
due to trauma there is structural change causing instability
often have a hills sach lesion or bankarts defect
what is a hills sach lesion?
often seen in polar type I on the stanmore triangle
a posterolateral humeral head compression fracture often secondary to recurrent anterior dislocation.
what is a bankarts defect?
Anterior labral pathology, often in trauma the shoulder labrum becomes detached
often seen in stanmore type I traumatic structural shoulder instability
what is the main treatment for stanmore type I shoulder instability?
Laberal repair
why does trauma cause instability in stanmore type I?
trauma causes a structural abnormality that damages both dynamic and static stabilisers
what is stanmore type II instability?
atraumatic structural
what is atraumatic structural stanmore type 2 shoulder instability?
There is a naturally looser capsule ie due to ehlor danlos causing shoulder dysfunction
what is the main treatment for stanmore polar II shoulder instability (atraumatic structural)?
capsular shift
what is stanmore polar III shoulder instability?
muscle patterning non structural
what causes stanmore polar III muscle patterning non structural?
The muscles no longer stabilise the shoulder for example pec major normally pulls the shoulder forward and lat dorsi back
‘capsular dysfunction due to abnormal muscle patterning’
what is the main treatment for polar type III muscle patterning non structural shoulder instability?
physiotherapy
what is the management of traumatic shoulder dislocation?
safe reduction of acute dislocation
analgesia, restore function and prevent future instability
what are clinical tests for instability?
sulcus sign: the arm is straight down and traction is placed inferiorly. You get a depression below the acromion
Anterior and posterior draw test
anterior apprehension test
relocation test
what is shoulder impingement?
A form of rotator cuff dysfunction where the greater tuberosity of the humerus engages with the underside of the acromion.
what are causes of shoulder impingement?
weak rotator cuff (main cause)
overgrown acromion meaning there isn’t enough space for greater tuberosity
poor scapula muscles
what is the main cause of shoulder impingement?
weak rotator cuff
what is the typical presentation of shoulder impingement?
over 40
anterior-superior pain often described as in the muscle
weakness secondary to pain
what are clinical tests for impingement?
neers sign (stabilise scapula whilst putting arm into maximal elevation, positive if pain is reproduced)
Jobes test: empty can test (90 degrees abduction, thumb pointing down and resist elevation
hawkins test: arm 90 degrees elevated, internally rotated and put in differents degrees of abduction/adduction
what is the management of shoulder impingement?
reduce pain with analgesia or steroid injections
Physiotherapy
Surgery to create more space
