Shoulder instability Flashcards
What features contribute to shoulder stability (anatomy)
- Labrum: deepens socket - Articular -Cartilage thinner thicker peripheral
capsule/ligaments - Musculature
- Synovial fluid - cohesion
- Negative intra articular pressure
- Slight tilt of glenoid fossa - lost with rounded shoulders
- Narrow glenoid fossa = more instability
how can translation influence instability
- Translation: movement of humerus on glenoid
- instability: symptoms associated with unwanted translation
circle of stability
- Since the capsule is round is stretches on both sides of the head
Degree of instability
- had the jt dislocated or subluxed before
-Nature of the shoulder instability
- Did we have an acquired laxity: dislocation or sublux
- Congenital: poor collagen, disease that affects
- Repetitive motions
Classifications of shoulder instability
- TUBS: traumatic Unilateral/Unidirectional Bankart Lesion Surgery
- AMBRI: Atraumatic Multidirectional Bilateral Rehab Inferior capsular shift
Responds well to rehab
GH translation grades
- humeral translation:
- Grade 0: none/no translation
- Grade 1: mild/humeral head moves slightly up face of glenoid
- Grade 2: moderate/humeral head rides up glenoid face to but not over the rim
- Grade 3: severe/humeral head rides up and over the glenoid rim
Usually reduces when stress removed
May remain dislocated when stress removed (rare)
Translation for the GH joint norms
- posterior
- inferior
- anterior
- Posterior translation: normal = 3-20 mm; ½ width of head
- Inferior translation: 5-15 mm
- Anterior translation: 2-13 mm; normal ¼ width of head
Mechanism of shoulder instability
- traumatic
- atraumatic
- overuse
Traumatic mechanism of shoulder instability
- 90º of Abduction and ER with Habduction = most common dislocation
- Can dislocate posterior but must land on an outstretched hand in IR
Atraumatic mechanism of shoulder instability
- 5% of dislocation
- AMBRI
Associated conditions with shoulder instability
- Bankart lesion: anterior inferior tear in labrum
- Hills sachs lesion: impaction fracture from an anterior dislocation
- HAGL lesion: humeral avulsion glenoid ligament
- Axillary Nerve injury: damaged with dislocation at times
Management trends with immobilization after dislocation
- Study that looked immobilization times: 1 week vs 4 weeks
- 10 years 50% in both groups recurrence
- 25 years: both groups had changes
Age management trends with shoulder dislocations
- Should you do surgery for younger people to increase stability
- Under 30 they immobilize longer to protect from themselves (usually more than 3 weeks
- Over 30 they immobilize 1-2 weeks
Position of immobilization in management trends for shoulder dislocation
- does not affect healing
TUBS: managment in protective phase
- activity restriction 6-8 weeks
- Protected ROM: Against motion they dislocated (go slow into ABD/ER)
- Isometrics: Turn muscles on with Submax isometrics
- By 6 weeks increase to 40-45º of ER
TUBS: management in controlled motion phase goals
- Increase shoulder mobility
- Increase stability and strength
Return to function phase TUBS management
- Strength balance: pec major, lats, teres major
*Need to coordinate endurance and call on muscles when needed
*Propception to tell when those muscle need to turn on - Coordination of shoulder and scapula
- Endurance: proprioception thrown off with fatigue
- Eccentric training
- Increasing speed and control
- Stimulating functional movements
Return to maximal function phase TUBS management
- typically for excessive sports esp with throwing
- usually rehab is 10-16 weeks if they are returning to these sports
AMBRI management
- Usually have accommodate to increased laxity
- Identify specific movement impairments at the GH and ST joints
- Re-establish active control using manual cues and beginning with limited motion
- Gradually increase: range of active control, endurance, strength and complexity of movement
- 6 phase program
