Shoulder Complex V: Test 3 Flashcards
prevalence of dislocation
GH is most commonly dislocated joint
cause of anterior GH dislocation
most common
mechanism = ER and ABD with FOOSH
anterior inferior direction
cause of posterior GH dislocation
less common (2-4%)
mechanism = 90 degrees of flexion with FOOSH
structures involved with dislocation
stretch/tear capsule/ligaments
possibly labrum (bankart lesion)
possibly SLAP
describe fibrocartilage
thicker and concave vs. articular cartilage
outer = thick
inner = thin
widens and deepens joint surface
locations of fibrocartilage
shoulder and hip labrum
SC, tibiofemoral, AC, ulnotriquetral, intervertebral, and pubic symphysis joints
cells of fibrocartilage
fibro and chondrocytes
what collagen makes up fibrocartilage
outer = mainly type I
-resist tension for stabilization
-majority type in all fibrocartilage including labrum
inner = lesser type II, III, and IV
-resist compression for shock absorption
vascularity of fibrocartilage
outer = vascular and neural; attributes to proprioception/kinesthesia like ligaments/annulus for stabilization
inner = hypo vascular/hypo neural/alymphatic
etiology of fibrocartilage damage
tears including possibly with RTC/dislocations
gradual/repetitive stresses including impingement
describe the healing of fibrocartilage
better in periphery
tensile strength initially improves at 3-5 weeks
even greater strength when dense fibrous tissue fills in at 8-12 weeks `
MET focus for distinctive fibrocartilage
tissue integrity/proliferation with vascularity issues
stabilization due to stabilizing role of fibrocartilage
other possible damages/involved structures with dislocation
fx aka hill Sachs lesion = compression fracture of humeral head
RC tears
neuromuscular structure compromise
symptoms fo dislocation
trauma in characteristic position
acute presentation
signs fo dislocation
ROM = limit/pain in most directions
RST/MMT = weak/pain in most directions
stress levels = likely + depending on structure involved
possibly + special tests for labrum
what are the special tests for the labrum
anterior instability (+ apprehension, + relocation)
anterior labrum (speeds test)
posterior inferior labrum (jerk test)
SLAP
special tests for fx
olecranon-manubrium percussion test
bony apprehension test
PT Rx for dislocation
immobilization up to 6 weeks
improve RC activation with contralateral UE use and ips hand squeezing activities
POLICED
shorter immobilization periods favor what with dislocation
muscle integrity
proprioception
peripheral and central neural activity
dynamic stability
MET focus for dislocation
stabilization
tissue integrity and proliferation
for anterior dislocation ER, FLX, and ABD are initially contraindicated so do isometrics/isotonics into opposite directions
prognosis for shoulder dislocation
recurrent dislocations are highly likely of over 30 years old
remember healing of all potentially involved tissue
MD Rx for dislocation
arthroscopic or open procedure
typically 3-6 month prognosis
Full ROM under anesthesia
follow protocols
what is a coracoid transfer
reposition of coracoid process and coracobrahcialis and short biceps head to GH neck
what is a capsular shift
aka capsuloraphy
most commonly done
overlap of torn portions of capsule folds
