Shoulder Instability Flashcards
bankart lesion
Tear of the glenoid labrum in the anterior region of the glenoid
Reverse Bankhart lesion
Tear of the glenoid labrum in the posterior region of the glenoid
Hill sachs lesion
Compression fracture of the humeral head occurring as a result of traumatic dislocation anteriorly
Occurs at the posterior lateral humeral head in response to anterior dislocation
ER , abduction and anterior force on humerus, humeral head(postlat) is forced onto glenoid rim
reverse hill sachs
Humerus is internally rotated, flexed, and adduction
and posterior translation of the humerus onto the glenoid rim
occurs anteromedial and from posterior dislocation
Anterior instability
90-95%
unidirectional with traumatic onset
combined position of abduction and external rotation
May have anteroinferior labrum disruption
posterior instability
2 to 10%
uniDirectional with repetitive loading (bench press)
Combine position of adduction and internal rotation
May have posterior labrum disruption
Multi directional instability
1-3%
not typically associated with traumatic episodes
Congenital or acquired laxity
Connective tissue disorder, possibly
MOI for anterior dislocations
Fall with a combination of abduction extension, and a posteriorly directed force on the arm
Fall on an outstretched hand is a common mechanism in the elderly
Atraumatic injury, MOI
Anatomical anomaly
General laxity
Poor muscle balance
Scapular dyskinesis
CT diseases like ehlers danlos syndrome or Marfan syndrome
acquired instability
Gradual development of laxity
Excessive ER
Posterior Glenohumeral joint capsular tightness
strength imbalance
clinical presentation of traumatic injury
Depends on etiology, direction of instability, severity, and frequency
pain generalized the shoulder, but localized to the tissues involved
Apprehensive to moving arm out from body
clinical presentation of atraumatic injury
General multi joint hypermobility
Loose inferior capsule
Atrophy shoulder girdle
Dysfunctional movement patterns
Observation for instability
protective posture
Presence of observable deformity, or muscle atrophy
Strength for instability examination
Limited by pain, weak abduction and external rotation, especially in the end ranges
Ability to coactivate dynamic stabilizers lightly diminished
check RC and scapular muscles
anterior instability clinical item cluster
apprehension test
Relocation test
Surprise test
Anterior drawer test
Posterior instability test
Jerk test
Labral tear test
Kim test
Biceps load test two
Risks for recurring dislocations
age related
Patients in their 20s have 60% rate at recurrence
Patients in their 30s have a 20% rate of recurrence
Gender more men than woman
Reduced risk of recurrence with fractures, including body Bankhart and greater tubercle fracture
Considerations for rehab
onset of instability
Degree of instability
Frequency of episodes
Direction of instability
Concomitant abnormalities or injuries
end range neuromuscular control
Pre-morbid activity level
Anterior instability, rehab phases
1- acute phase
2- intermediate phase
3- advanced strengthening
4- return to activity
acute phase goals
Diminished pain inflammation, and muscle guarding
Promote and protect healing, soft tissues
Prevent negative effects of immobilization
Reestablish, baseline, dynamic joint stability
Prevent further damage to the GH joint capsule
acute phase interventions
Immobilization
PROM- early motion in a protective range
Strengthening- sub maximal pain-free isometrics
dynamic stabilization
-IR/ER performed in scapular plane
-flexion performed at 100° flexion 10° horizontal adduction
-closed Kinetic chain
Criteria to enter the intermediate phase
reduced pain and improved motor control
intermediate phase goal
To reestablish muscle balance and restore full active range of motion
intermediate phase interventions
Passive range of motion and active assisted range of motion performed to the patient tolerance
internal and external rotation at 90° of abduction
Strength stabilization at mid range
Criteria to enter the advanced strengthening phase
minimal pain
Full range of motion
Symmetric capsular mobility
Good strength 4.5 MMT
Strength, endurance, and dynamic stability of the scapulothoracic and upper extremity regions
Advanced strengthening phase goals
emphasis on strength and dynamic stabilization at end ranges
Return to full daily activities
Advanced strengthening phase interventions
Low and high repetitions
Incorporation of co contraction and dynamic stabilization
Begin low intensity plyometrics for the athlete returning to sport
return to activity phase goals
Emphasis of the space that you perform strength program, dynamic stability and neural muscular control
maintain full functional and pain-free range of motion
Sports specific activities with plyometrics PNF and isotonic strengthening as it relates to the individual
