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MSK 1 - Shoulder > Shoulder Complex- Dislocation thru Humeral Apophysitis > Flashcards

Shoulder Complex- Dislocation thru Humeral Apophysitis Flashcards

1
Q

What is the most dislocated joint?

A

GH joint

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2
Q

What is the cause of an anterior dislocation ?

A

ER and ABd with FOOSH
(closed packed positions with bony contact, taut ligaments & capsule)

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3
Q

What type of shoulder dislocation is most common?

A

anterior

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4
Q

What direction does the humeral head go in with an anterior dislocation?

A

Anterior - inferior

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5
Q

What is the cause of a posterior dislocation?

A

90˚ flexion with FOOSH

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6
Q

How common are posterior dislocations?

A

only 2-4% of dislocations

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7
Q

What causes recurrent dislocatons?

A

Pathological instability
- can cause dislocations with low force things
- most often in young people

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8
Q

What are the three types of shoulder dislocations?

A

Anterior
Posterior
Recurrent

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9
Q

What structures are most involved with dislocations of the shoulder?

A

Stretch/tear capsule/ligaments

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10
Q

What can also possibly be damaged with dislocation?

A

Anterior labrum tear (aka Bankart lesion)
SLAP

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11
Q

What type of impingement likely results from a dislocation?

A

Hypermobility

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12
Q

What makes fibrocartilage different than articular cartilage?

A

thicker and concave vs articular cartilage

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13
Q

What are some characteristics of fibrocartilage?

A

Outer potion is thick
inner portion is thin
Widens and deepens joint surface

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14
Q

Where can we find fibrocartilage?

A
  • Shoulder and hip labrum
  • SC, Tibiofemoral, AC, ulnotriquestral, intervertebral, and pubic symphysis joints
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15
Q

What makes up fibrocartilage?

A
  • fibro- and chondryocytes
  • collagen
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16
Q

What is outer fibrocartilage made out of? What does it do?

A

Type I collagen
- resists tension for stabilization

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17
Q

What is the majority type of all fibrocartilage?

A

Type I collagen to resist tension - including glenoid labrum

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18
Q

What is inner fibrocartilage made up of? What does it do?

A

Secondarily and less type II, III, and IV collagen - resists compression for shock absorption

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19
Q

What is the function of outer fibrocartilage?

A

Neural attributes for proprioception/ kinesthesia like ligament/annulus for STABILIZATION

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20
Q

What kind of tissue is outer fibrocartilage?

A

Vascular and neural

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21
Q

What type of tissue is inner fibrocartilage?

A

Hypo- or avascular/aneural/alymphatic

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22
Q

What causes fibrocartilage to form?

A
  • acute tears with RTC tears/dislocations
  • Gradual tears from repetitive and/or extreme motion and compressive stresses often with sports and impingement
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23
Q

Where is fibrocartilage better at healing? WHY?

A

The periphery due to greater vascularity

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24
Q

When does tensile strength of fibrocartilage initially improve?

A

~3-5 weeks

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25
When does even greater tensile strength improve?
When dense fibrous tissue fills in at ~8-12 weeks
26
What should we do if no improvement by 8-12 weeks
Back to doc
27
What is the MET focus with fibrocartilage?
Tissue integrity/proliferation with vascularity issues Stabilization due to stabilizing role of fibrocartilage
28
What are other possible complications with a disclocation?
* Fractures aka Hill Sachs Lesion - compression fracture of humeral head * RC tear(s) * Neurovascular structures in extreme cases
29
What are symptoms of shoulder dislocations?
like impingement plus... - trauma in characteristic position - acute presentation
30
What are signs we will find of a shoulder dislocation?
* ROM - limited and painful most directions * Resisted/MMT - weak and painful most directions * Stress tests - likely positive depending on structure involved
31
What are some possible special tests for labrum?
Anterior instability Anterior labrum Postero-inf labrum
32
What are anterior instability special tests?
+ apprehension + relocation Apprehension ( may also be positive with general hypermobility)
33
What are the LR of anterior instability anterior dislocation special tests?
LR + = 39.68 if both + LR - = 0.19 if both -
34
What is a test for the anterior labrum?
Speeds * high sens (rule in)
35
What is a test for the postero-inferior labrum?
Jerk test LR + 1.25-36.5
36
What are some possible SLAP tests for labrum with dislocation?
Sulcus with inferior drawer Biceps load Pain provocation Passive compression Yergason's
37
What are some possibly positive special tests for fracture with dislocation?
Olecranon-Manubrium percussion test Bony Apprehension Test
38
What is the benefit of the Olecranon-manubrium percussion test?
High spec/sens (rule out and in) LR + 84
39
What should we treat dislocation like? (other condition)
A worse case of impingement due to hypermobility/instability
40
How long is someone immobilized after dislocation of the shoulder?
Up to 6 weeks
41
How can we improve rotator cuff activation while immobilized?
Contralateral UE use Ipsilateral hand squeezing activities
42
What are some positives of a shorter period of immobilization?
muscle integrity proprioception peripheral and central neural activity dynamic stability
43
What are some pt rx for dislocation?
Immobilization POLICED
44
What does MET focus on with dislocation?
Stabilization Tissue integrity and proliferation
45
What are initial contraindications for anterior dislocations?
Abduction, Eternal rotation, and Flexion ROM
46
What movements are initially ideal for dislocations in terms of MET?
Isometrics and isotonics into opposite directions initially
47
What makes recurrent dislocations highly likely?
If under 30 years of age
48
What should we remember with prognosis of dislocations?
healing of all potentially involved tissue
49
What are some MD rx for dislocations?
Arthroscopic vs. open procedures
50
How long is the prognosis is the prognosis for MD dx (surgery)?
3-6 months
51
What is done while under anesthesia that ensures movment?
Full ROM
52
What is a coracoid transfer?
Reposition coracoid process and coracobrachialis and short biceps head to GH neck
53
What is a capsular shirt / capsuloraphy?
Overlap of torn portions of capsular folds
54
Which surgery is most common with dislocations?
Capsuloraphy
55
What type of fracture of the shoulder is common in the elderly?
Proximal humeral fracture
56
What is the etiology of a proximal humeral fracture?
FOOSH
57
What structures are involved with a proximal humeral fracture?
Surgical humeral neck
58
What is our dose response with fractures?
How we use the body - i.e. immobilization less than previously active
59
What are some complications with a proximal humeral fracture?
* Axillary artery damage * Adhesive capsulitis from prolonged immobilization
60
What can axillary artery damage lead to?
Coldness and blanching Emergency referral Possible avascular necrosis (tissue death)
61
What is the etiology of a clavicular fracture?
compression mechanism the long axis of clavicle
62
Where is the location of clavicular fractures?
Weak spot at S curve
63
What are complications of clavicular fractures?
Large displacement may require sx Epiphyseal plate injury as it is the last bone to ossify
64
When does the clavicle ossify?
18-25 years of age
65
What are some S&S of fracture in the UE covered
Olecranon - manubrium percussion test Apprehension test
66
When do we start PT with fractures?
When clinical union occurs between 4-8 week s
67
What is pain from fractures not typically from?
Bone
68
What is PT for fractures focused on?
Consequences of prolonged immobilization where every tissue is negatively influenced
69
What is proximal humeral apophysitis also known as?
Little League Shoulder
70
What is the prevalence of proximal humeral apophysitis?
rare but increasing
71
What population is most likely to get proximal humeral apophysitis?
Adolescents, biological males more than females, MOSTLY overhead throwers but also racquet sports
72
What is the etiology of proximal humeral apophysitis?
Growth with high activity
73
What are the pathomechanics of proximal humeral apophysitis?
- Bone grown exceeds rotator cuff lengthening - increased tendon tension - Growth plate is the weak spot as opposed to tendon in adults ** MOST often imflammation
74
What are complications with proximal humeral apophysitis?
avulsion and/or premature closure
75
What are symptoms of proximal humeral apophysitis?
* Gradual onset of shoulder pain with overuse * A "pop" may indicate trauma and an avulsion (most concerning with force) * Above etiology with possible loss of velocity
76
What are some signs of proximal humeral apophysitis?
Impingement like * resisted/MMT limited plus lower ER:IR strength ration in adolescent athletes with GIRD >1 * Special tests positive for impingement , up to 30% with GIRD > 1 * Palpation - TTP over anterio- and posterolateral aspect of proximal humerus
77
What is the most common sign of proximal humeral apophysitis?
TTP over antero- and posterolateral aspect of proximal humerus
78
What should patient education include with proximal humeral apophysitis?
Soreness rule Load management (pitch count, active rest, rest days, alternative defensive postions) Movement cues (throwing mechanics)
79
What are the rx for proximal humeral apophysitis?
POLICED throwing mechanics patient ed normalize motion Careful stretching Return to Play
80
What can normalizing motion do with proximal humeral apophysitis?
improve GIRD ratio
81
Why should we be careful with prolonged stretching with proximal humeral apophysitis?
Vulnerability of growth plate
82
What should MET include for proximal humeral apophysitis?
Cuff but also trunk, scapular, and LE impairements
83
What should we have caution with MET for proximal humeral apophysitis?
muscles/tendons attached to growth plate
84
How early do most return to preinjury levels with proximal humeral apophysitis?
as early as 2 months, but possibly up to 2-8 months
85
How long until return to competition with an avulsion with proximal humeral apophysitis?
~4.5 months
86
When does the growth plate typically close?
Between 16-20 years of age
87
Can proximal humeral apophysitis be recurrent?
Yes

MSK 1 - Shoulder (5 decks)

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