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MS Test 2: Upper Quarter > Shoulder Instability > Flashcards

Shoulder Instability Flashcards

(59 cards)

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1
Q

What is laxity?

A

ability to translate humeral head on glenoid which is normal

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2
Q

What is instability?

A

unwanted or excessive translation of HH on glenoid, causing discomfort or dysfunction

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3
Q

What is worse a subluxation or dislocation?

A

dislocation

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4
Q

During joint play which direction should usually be more in a normal person?

A

inferior glide

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5
Q

What structures help with shoulder stability?

A

labrum, ligaments and capsule, biceps, RC, scapula, negative intra articular pressure

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6
Q

How much does the labrum increase depth of glenoid fossa?

A

50% increase

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7
Q

What is primary restraint during early shoulder ROM?

A

jt negative articular pressure

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8
Q

What is primary restraint during mid range shoulder ROM?

A

muscle function

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9
Q

What is primary restraint during late shoulder ROM?

A

capsule

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10
Q

When does the biceps stabilize the shoulder jt?

A

in ABD and ER

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11
Q

How does the scapula help stabilize the shoulder jt?

A

during motion the scap must upwardly rotate to help keep glenoid in line with HOH

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12
Q

What is the orientation of glenoid fossa to the coronal plane?

A

30-45 degrees

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13
Q

What happens to intra articular jt pressure after surgery or trauma?

A

it is often lost resulting in 40-60% increased translation

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14
Q

What is TUBS?

A

Traumatic etiology
Unidirectional
Bankart lesion (inferior glenoid labrum)
Surgical intervention

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15
Q

What is AMBRI?

A 
Atraumatic
Multidirectional
Bilateral shoulder findings
Rehab intervention
Inferior capsular shift = surgical intervention
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16
Q

What is a SLAP lesion?

A

superior labrum anterior to posterior

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17
Q

Will rehab or surgery prevent further dislocations?

A

probably not as reoccurrence rate is high

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18
Q

What is a macro trauma SLAP lesion?

A

forceful abd ext and ER, FOOSH, traction force, weight lifting, blow to shoulder

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19
Q

What is a micro trauma slap lesion?

A

underlying hyper mobility, overhead athletes, sx of clicking, catching, popping, pain with overhead activity

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20
Q

What is Dr. Andrews theory for MOI?

A

biceps must work eccentrically during extension while arm is following through pulls on labrum

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21
Q

What is Dr. Burkharts theory for MOI?

A

during ABD and ER in late cocking phase of throwing the biceps is twisted at base

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22
Q

What theory is correct?

A

both are as they both happen during throwing

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23
Q

What is a type 1 SLAP lesion?

A

11% of labrum issues, usually as a result of RC pathology, biceps still intact, fraying and degeneration of tissue

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24
Q

What is a type 2 SLAP lesion?

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A

41% of labrum issues, superior labrum and biceps detached from glenoid, results instability, most common injury for overhead athletes

25
What is a type 3 SLAP lesion?
bucket handle tear 33% of labrum issues, biceps still intact and central part of labrum displaced into joint with periphery still intact associated with traumatic instability
26
What is a type 4 SLAP lesion?
same as type except biceps torn as well
27
What is PP for anterior dislocation/subluxation?
overhead athlete in ABD/ER, impingement type pain, loss of IR, during late phase cocking phase of throwing
28
What is PP for posterior subluxation?
less common but arm is flexed adducted and IR with a poster blow, loss of elevation and ER, pain with pushing, pain in follow through phase of throwing
29
What is the Beighton scale?
ligament laxity, passive 1st/5th greater than 90, hyperABD of thumb, hypertext of elbow and knees, forward bend and palm on floor
30
What score is needed for global laxity on Beighton?
6/9
31
What will anterior instability present like?
secondary impingement
32
What special tests should be performed for instability?
A/P drawer, load and shift, apprehension
33
What are keys to successful non op rehab?
improve static and dynamic stabilization, activate RC for adequate compressive forces, improve proprioception, increase scap strength and control, improve muscular endurance
34
In acute phase of treatment of non op SLAP what are goals?
reduce pain and inflammation, promote capsular healing, minimize muscle atrophy,
35
What are interventions for acute phase of non op SLAP?
sling, Light ROM, Isometrics, scap muscle training, proprioception drills
36
In sub-acute phase of treatment of non op SLAP what are goals?
restore shoulder motion, establish muscle balance, improve scap strength
37
What are interventions in sub acute phase of non op slap lesion?
isotonics in controlled motion, start dynamic stabilization, dynamic scap strengthening, endurance training, core stab.
38
What are goals in chronic phase of non op slap treatment?
restore full ROM and strength, initiate dynamic movements
39
What are interventions for chronic phase of non op slap?
perturbations, RC strengthening, endurance exercises, progress activity level
40
What is a Putti platt/magnuson stack procedure?
shortens sub scap, prevents anterior instability but loses ER and normal motion, can't return to throwing sport
41
What is a modified Bristow/Latarjet?
shaves part of coracoid and puts on glenoid neck same losses as puttiplatt
42
What is a Bankart repair?
reattachment of avulsed anterior capsule to glenoid rim
43
What is a Bankart indicated?
symptomatic recurrent dislocation, failed conservative therapy, unidirectional anterior instability
44
What are contraindications for Bankart?
if pt voluntarily causes dislocation, seizures, multidirectional instability
45
What is main component of a open bankart repair?
cuts subscapularis
46
What are contraindications after open bankart for rehab?
avoid, early aggressive motions, excessive ER and extension, resisted or forceful IR, there is lengthy immobilization
47
What is early motion for open Bankart?
immediate to tolerance, ER/IR in scapular plane
48
What is strength in rehab after open Bankart?
submax isometrics immediately, isotonic in week 3, plyos in week 10
49
What are precautions for arthroscopic bankart?
slight for 6 weeks, no overhead activities for 4 weeks, no excessive ER or extension for 4 weeks
50
What rehab is slower open or arthroscopic?
arthro although they feel less pain so educate them not to rush process
51
When will patient get full ROM after arthro Bankart?
12 weeks
52
What is most common procedure for anterior inferior instability?
arthroscopic capsular plication, capsule is shifted posteriorly, must have atraumatic instability
53
What is typical Type 1 SLAP lesion surgery rehab?
immediete PROM and AAROM, full PROM by 2 weeks begin AROM at 2 weeks, isotonics at week 2, strength at week 4-6
54
What are precautions for type 2 SLAP repair?
control forces 8 weeks, no overhead motions for 4 weeks, no isolated biceps for 8 weeks, no resisted biceps for 12 weeks
55
What is type 4 slap repair rehab?
sleep immobilizer for 4 weeks, elevation to only 90 for 4 weeks, , Full ROM by week 10, no isolated biceps for 4 months, isotonic at week 4-6, full activity 6-9 months
56
What is a biceps tenodesis?
removal of long head of biceps from glenoid
57
Where do they reattach biceps?
proximal humerus
58
When is bicep tenodesis indicated?
irreversible changes to bicep tendon, 25% tearing or atrophy, any lunation out of bicipital groove
59
What is rehab considerations for bicep tenodesis?
no bicep loading for 6 weeks

MS Test 2: Upper Quarter (5 decks)

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