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MS Test 2: Upper Quarter > Shoulder Instability > Flashcards

Shoulder Instability Flashcards

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?

A

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

25
Q

What is a type 3 SLAP lesion?

A

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
Q

What is a type 4 SLAP lesion?

A

same as type except biceps torn as well

27
Q

What is PP for anterior dislocation/subluxation?

A

overhead athlete in ABD/ER, impingement type pain, loss of IR, during late phase cocking phase of throwing

28
Q

What is PP for posterior subluxation?

A

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
Q

What is the Beighton scale?

A

ligament laxity, passive 1st/5th greater than 90, hyperABD of thumb, hypertext of elbow and knees, forward bend and palm on floor

30
Q

What score is needed for global laxity on Beighton?

A

6/9

31
Q

What will anterior instability present like?

A

secondary impingement

32
Q

What special tests should be performed for instability?

A

A/P drawer, load and shift, apprehension

33
Q

What are keys to successful non op rehab?

A

improve static and dynamic stabilization, activate RC for adequate compressive forces, improve proprioception, increase scap strength and control, improve muscular endurance

34
Q

In acute phase of treatment of non op SLAP what are goals?

A

reduce pain and inflammation, promote capsular healing, minimize muscle atrophy,

35
Q

What are interventions for acute phase of non op SLAP?

A

sling, Light ROM, Isometrics, scap muscle training, proprioception drills

36
Q

In sub-acute phase of treatment of non op SLAP what are goals?

A

restore shoulder motion, establish muscle balance, improve scap strength

37
Q

What are interventions in sub acute phase of non op slap lesion?

A

isotonics in controlled motion, start dynamic stabilization, dynamic scap strengthening, endurance training, core stab.

38
Q

What are goals in chronic phase of non op slap treatment?

A

restore full ROM and strength, initiate dynamic movements

39
Q

What are interventions for chronic phase of non op slap?

A

perturbations, RC strengthening, endurance exercises, progress activity level

40
Q

What is a Putti platt/magnuson stack procedure?

A

shortens sub scap, prevents anterior instability but loses ER and normal motion, can’t return to throwing sport

41
Q

What is a modified Bristow/Latarjet?

A

shaves part of coracoid and puts on glenoid neck same losses as puttiplatt

42
Q

What is a Bankart repair?

A

reattachment of avulsed anterior capsule to glenoid rim

43
Q

What is a Bankart indicated?

A

symptomatic recurrent dislocation, failed conservative therapy, unidirectional anterior instability

44
Q

What are contraindications for Bankart?

A

if pt voluntarily causes dislocation, seizures, multidirectional instability

45
Q

What is main component of a open bankart repair?

A

cuts subscapularis

46
Q

What are contraindications after open bankart for rehab?

A

avoid, early aggressive motions, excessive ER and extension, resisted or forceful IR,

there is lengthy immobilization

47
Q

What is early motion for open Bankart?

A

immediate to tolerance, ER/IR in scapular plane

48
Q

What is strength in rehab after open Bankart?

A

submax isometrics immediately, isotonic in week 3, plyos in week 10

49
Q

What are precautions for arthroscopic bankart?

A

slight for 6 weeks, no overhead activities for 4 weeks, no excessive ER or extension for 4 weeks

50
Q

What rehab is slower open or arthroscopic?

A

arthro although they feel less pain so educate them not to rush process

51
Q

When will patient get full ROM after arthro Bankart?

A

12 weeks

52
Q

What is most common procedure for anterior inferior instability?

A

arthroscopic capsular plication, capsule is shifted posteriorly, must have atraumatic instability

53
Q

What is typical Type 1 SLAP lesion surgery rehab?

A

immediete PROM and AAROM, full PROM by 2 weeks begin AROM at 2 weeks, isotonics at week 2, strength at week 4-6

54
Q

What are precautions for type 2 SLAP repair?

A

control forces 8 weeks, no overhead motions for 4 weeks, no isolated biceps for 8 weeks, no resisted biceps for 12 weeks

55
Q

What is type 4 slap repair rehab?

A

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
Q

What is a biceps tenodesis?

A

removal of long head of biceps from glenoid

57
Q

Where do they reattach biceps?

A

proximal humerus

58
Q

When is bicep tenodesis indicated?

A

irreversible changes to bicep tendon, 25% tearing or atrophy, any lunation out of bicipital groove

59
Q

What is rehab considerations for bicep tenodesis?

A

no bicep loading for 6 weeks

MS Test 2: Upper Quarter (5 decks)

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