Shoulder Instability Flashcards
What is the shoulder joint much less stable than?
Hip ball and socket joint
What are types of static stabilizations in the shoulder?
Ligaments
Capsule
Bony anatomy
What is a dynamic stabilizer in the shoulder?
Muscles
What are the different types of instabilities in the shoulder?
Traumatic
Atraumatic
Acquired
Who is shoulder instability more common in?
3x more common in men than women
What is traumatic instability?
Subluxation
Dislocation
What can a shoulder dislocation lead to?
Hill-Sachs lesion
Boney bankart
Labral tear
Axillary nerve injury
What is a bankart lesion?
Tear of glenoid labrum in the anterior region
What is a reverse bankart lesion?
Tear of glenoid labrum in the posterior region
What is a Hills-Sach lesion?
Injury to humeral head due to anterior dislocation
What is the most common type of disability?
Anterior disability (ER, abduction, anterior directed force)
What are the causes of atraumatic instability?
Anatomical anomaly
General laxity
Poor muscle balance
Scapular dyskinesis
Connective tissue diseases (Ehlers-Danlos and Marfan syndrome)
What are the causes of acquired instability?
Gradual development of laxity (pitchers)
Excessive ER
Posterior GH joint capsular tightness
Strength imbalance
What is the clinical presentation of someone with traumatic instability?
Shoulder pain but localized to tissues involved (scared to move arm out from body)
What is the clinical presentation of someone with atraumatic instability?
Multi joint hyper mobility
Atrophy of shoulder girdle
Dysfunctional movement patterns
Who is at greater risk for recurrence of shoulder dislocations?
Younger patients in their 20s and men
What results in a reduced risk of shoulder dislocation?
Boney bankart and greater tubercle fracture (due to surgical intervention)
What are the 4 phases of a rehab program for anterior instability?
Phase 1- acute
Phase 2- intermediate
Phase 3- advanced strengthening
Phase 4- return to activity
What are some exercises that are good to be used in the acute phase (phase 1)?
Rhythmic stabilization for IR/ER/shoulder flexion
Closed chain (arms held out against wall)
Scapular re training
What are some exercises that can be used for the intermediate phase (phase 2)?
Rotator cuff strengthening (moving in early to mid range in multiple planes)
Closed chain (plank position)
Balancing with hand on a ball on the wall
What are some exercises for the advanced strengthening phase (phase 3)?
Rotator cuff strengthening at end range
Neuromuscular training
Closed chain (wall push up on ball)
What are some exercises for the return to activity phase (phase 4)?
Exercises that reflect what they want to return to
What is TUBS?
Traumatic
Unidirectional (anterior, posterior, or inferior)
Associated bankart lesion
Surgical repair
What is the prognosis of TUBS?
Good
What is AMBRI?
Atraumatic
Multidirectional
Bilateral
Rehab
Inferior capsular shift (if surgery is done)
What is the prognosis of AMBRI?
Less certain
What position does an anterior GH dislocation usually occur in?
Anterior force on shoulder with arm abducted and ER (posterior force on forearm or hand)
What position does a posterior GH dislocation occur in?
Posterior force on shoulder with arm flexed and IR
What is the position where inferior GH dislocation often occurs?
Inferior force on shoulder with arm in abduction
