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Ortho Exam 2 > Shoulder Instability > Flashcards

Shoulder Instability Flashcards

1
Q

which joint is most likely to be hypermobile

A

GH joint

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2
Q

rate of primary dislocation overall

A

3:1 male to female

9:1 in the 21-30 yo group

3:1 female to male in the 60-80 yo group

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3
Q

reoccurance

A

80-95% in young adults

10-15% age > 45 yo

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4
Q

MOI

A

traumatic

atraumatic

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5
Q

traumatic –> MOI

A

majority of cases

severe pain

deformity

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6
Q

traumatic injury

A

anterior and posterior dislocation

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7
Q

trauma forces arm –> anterior dislocation

A

into ER and ABD (90/90 position)

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8
Q

% of all traumatic dislocation –> anterior dislocation

A

95%

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9
Q

immediately post trauma –> anterior dislocation

A

arm positioned in slight ABD and ER

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10
Q

trauma forces arm –> posterior dislocation

A

directly posterior

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11
Q

% of all traumatic dislocations –> posterior dislocation

A

5%

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12
Q

classic –> posterior dislocation

A

steering wheel injury

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13
Q

immediately post trauma –> posterior dislocation

A

arm positioned in ADD and IR

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14
Q

why should reduction be done ASAP

A

due to increased pain

potential vascular supply injury

potential injury to thoracic outlet structures

soft tissue response

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15
Q

usually –> Atraumatic

A

multidirectional instability

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16
Q

what cant stabilize the joint –> Atraumatic

A

bony structures

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17
Q

what does the pt have –> Atraumatic

A

severe ligamentous laxity

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18
Q

what does atraumatic create

A

chronic fatigue (overuse) of muscles

prolonged microtrauma

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19
Q

normal stability components

A

bone

capsuloligamentous (static)

muscular (dynamic)

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20
Q

movement

A

primary or secondary

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21
Q

primary movement

A

side of translation

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22
Q

secondary movement

A

side opposite of translation

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23
Q

bony stability

A

coracoacromial arch

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24
Q

muscular stability

A

LHB

RC

scapular stabilizers

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25
Q

capsuloligamentous stability

A

capsule

capsular GH ligs

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26
Q

grading anterior stability

A

grades 1-3

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27
Q

grade 1 –> anterior stability

A

25-50% translation

w/o dislocation

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28
Q

grade 2 –> anterior stability

A

> 50% translation

dislocation w/ spontaneous reduction

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29
Q

grade 3 –> anterior stability

A

> 50%

dislocation w/o reduction

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30
Q

classification system

A

FEDS classification

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31
Q

FEDS

A

frequency

etiology

direction

severity

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32
Q

frequency –> FEDS

A

solitary = 1 episode

occasional = 2-3 episodes

frequent >5 times

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33
Q

etiology –> FEDS

A

traumatic

atraumatic

34
Q

direction –> FEDS

A

anterior (out the front, most common)

posterior (out the back, 2nd most common)

inferior (out the bottom, least common)

35
Q

severity –> FEDS

A

did you need to help relocate the shoulder?

dislocation?

subluxation?

36
Q

the examination

A

CHARTS

37
Q

C –> CHARTS

A

pain

instability

38
Q

H –> CHARTS

A

FEDS

MOI

magnitude of force

39
Q

A –> CHARTS

A

humeral head position

postural components

palpation

40
Q

humeral head position –> CHARTS

A

observation

41
Q

observation –> CHARTS

A

anterior &/or inferior to acromion

acromion is prominent

shoulder appears square

42
Q

palpation –> CHARTS

A

feel for position of humeral head and clavicle

usually tenderness at insertion of anterior and inferior GH ligs

43
Q

R –> CHARTS

A

AROM

PROM

accessory ROM

resistive ROM

44
Q

AROM –> CHARTS

A

acute and chronic

45
Q

acute AROM –> CHARTS

A

usually decreased w/ apprehension and guarding

pain esp movements in which anterior capsule is stretched

46
Q

chronic AROM –> CHARTS

A

excessive

47
Q

PROM

A

acute and chronic

48
Q

acute PROM –> CHARTS

A

decreased ER

especially @ 90 ABD

49
Q

accessory ROM –> CHARTS

A

expect anterior capsule laxity and posterior capsule tightness

50
Q

T –> CHARTS

A

tone and play

strength

length

51
Q

S –> CHARTS

A

acute and post acute

52
Q

acute S –> CHARTS

A

defer instability tests

53
Q

post acute S –> CHARTS

A

anterior

posterior

inferior/MDI

labrum

54
Q

anterior special tests

A

apprehension

jobe relocation test

anterior load/shift

55
Q

posterior special test

A

posterior load/shift

kim test

56
Q

inferior/MDI special test

A

sulcus sign

57
Q

labrum special test

A

crank test

apprehension test

58
Q

differential dx

A

neurological testing

59
Q

neurological testing –> differential dx

A

look for axillary nerve involvement

deltoid/weakness atrophy

teres minor weakness/atrophy

sensory loss over lateral portion of shoulder

60
Q

if nerve damage is apparent –> differential dx

A

EMG 3 wks post injury

61
Q

other dx might see –> differential dx

A

soft tissue injury

muscle tears

vascular damage

cervical pathology

62
Q

common dx accompanying instability

A

bankart lesion

hill-sachs lesion

63
Q

bankart lesion

A

avulsion or tear of anterior capsule and inferior labrum

inferior GH ligament pulls the inferior labrum away from the glenoid

64
Q

bony bankart lesion

A

chip fx of anterior inferior glenoid rim

65
Q

bankart lesion incidence

A

~87% w/ anterior dislocations

66
Q

bankart lesion is a

A

common cause of instability

67
Q

bankart repair

A

arthroscopic is the gold standard

open bankart is traditional

68
Q

what is the goal of bankart repair

A

restores tension to anteroinferior capsule and AIGHL

69
Q

where are the sutures –> bankart

A

through glenoid and capsulolabral tissue to anatomically repaid labrum back to glenoid rim

70
Q

hill-sachs lesion

A

impaction fx of posterior/superior aspect of humerus

d/t compression of humerus against the anterior/inferior glenoid rim

71
Q

hill-sachs could be

A

traumatic or atraumatic

72
Q

when is hill-sachs frequently found

A

recurrent anterior instability

73
Q

what can hill-sachs cause

A

painful catching

clicking or popping

74
Q

dx testing

A

x-ray

CT scan

MRI

75
Q

x-ray –> dx testing

A

can visualize bankart or hill-sachs lesion

need special views

76
Q

what view can a bankart lesion NOT be seen on

A

AP

77
Q

view for a bankart lesion

A

must use a modified axillary view (west point view)

78
Q

west point view

A

pt prone w/ arm in 90 ABD and neutral rotation

beam directed 25 degrees posterior to horizontal plane and 25 degrees medial to vertical plane

79
Q

what view must be used for hills-sach lesion

A

stryker notch view

80
Q

stryker notch view

A

pt is supine wi/ hand on top of head

beam is A/P, centered at coracoid and angled 10 degrees towards the head

evaluates posterior/superior humeral head

Ortho Exam 2 (17 decks)

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