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MSK 4 > Shoulder Instability > Flashcards

Shoulder Instability Flashcards

1
Q

What gender is more prone to shoulder instability?

A

Men are 3x more likely than women

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2
Q

What 4 components aid in shoulder stability?

A
  • Bony congruency enhance by labrum
  • Negative pressure GH joint
  • Muscle and tendons provide static and dynamic stability
  • Ligaments and joint capsule
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3
Q

What are the three classification of shoulder instability?

A
  • Traumatic (split into subluxation and dislocation)
  • Atraumatic
  • Acquired
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4
Q

What is a bankart lesion?

What is a reverse bankart lesion?

A

Bankart-tear of the glenoid labrum in the anterior region of the glenoid

Reverse Bankart-tear of the glenoid labrum in the posterior region of the glenoid

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5
Q

What is a Hills-Sachs lesion?

How does it differ from a reverse Hill-Sachs lesion?

A

compression fracture of the humeral head occurring as result of traumatic dislocation anteriorly

Hills-Sachs lesion is on posterolateral humerus
Reverse H-S lesion is anteromedial humerus

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6
Q

What are the common directions of instability?

A

Anterior (most common at 90-95%)- is unidirectional w/ traumatic onset and combination of ABD and ER positions, may bankart lesion

Posterior (2-10%)- unidirectional w/ repetitive loading such as bench press, combinations of ADD and ER position and may have reverse bankart lesion

Multidirectional (rare 1-3%)-not typically assoc. w/ traumatic episodes but is usually acquired or congenital

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7
Q

What are the common mechanisms of injury that could lead to shoulder instability?

A

Traumatic injury- ant. dislocations are common w. falling with a combo of ABD, EXT, and posterior directed force on the arm-falling onto outstretched arm is common MOI for elderly populations

Atraumatic Injury- anatomical anomaly, general laxity, poor muscle balance, scapular dyskinesis, CT diseases such as Marfan syndrome

Acquired Instability- gradual development of laxity due to excessive ER, posterior GH joint capsular tightness or strength imbalances

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8
Q

How would pain normally present in a patient with shoulder instability due to a traumatic event?

A

pain generalized to the entire shoulder but localize to the tissues involved and patient may be apprehensive to moving arm out from their body

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9
Q

What would the clinical presentation likely look like for a patient with shoulder instability due to an atraumatic injury?

A
  • general multi-joint hypermobility
  • loose inferior capsule
  • atrophy shoulder girdle
  • dysfunctional movement patterns
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10
Q

What strength deficits would most likely be observed in patients w/ shoulder instability, and what should we also examine besides shoulder musculature?

A
  • ROM limited by pain, weak ABD and ER (esp. at end range)
  • ability to co-activate dynamic stabilizers is diminished
  • Check RC and scapular muscles
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11
Q

What is the test-item cluster for anterior shoulder instability?

A

Apprehension Test
Relocation Test
Surprise Test

can also include anterior draw test

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12
Q

What test can help rule in posterior shoulder instabiltiy?

A

Jerk Test (especially good to rule out when paired w/ KimTest)

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13
Q

What tests can help rule in/out a labral tear?

A 
Kim Test (good for ruling out if paired w/ Jerk Test)
Biceps Load Test II
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14
Q

What populations are more likely to experience recurrence of shoulder instability?

A

patients in their 20’s (60% reoccurence compared to 20% for pts. in their 30’s)

Men more then women (47% recurrence in men compared to 27% in women)

reduced risk of recurrence w/ fractures including boney bankart and greater tubercle fracture

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15
Q

What are the key factors for consideration w/ rehab of an unstable shoulder?

A
  • Onset of instability
  • Degree of instability: sublux vs. dislocation
  • frequency of episodes
  • direction of instability
  • concomitant abnormalities/injuries
  • end range NM control
  • Pre-morbid activity level
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16
Q

What are the main goals of phase 1 of the rehab program for anterior shoulder instability?

What are the main interventions for this phase?

A

Phase 1-Acute Phase

  • diminish pain, inflammation, and muscle guarding
  • promote soft tissue healing
  • prevent negative effects of immobilization
  • reestablish baseline dynamic joint stability
  • prevent further damage to GH joint capsule

Interventions:

  • Immobilization
  • PROM-early motion in a protected range
  • Strengthening-submaximal, pain free isometrics
  • dynamic stabilization (IR/ER performed in scpaular plane, flexion performed at 100 deg flex, 10 deg horiz. ADD, closed kinetic chain)
17
Q

What is the criteria to enter phase 2 and what are the main goals of phase 2 of the rehab program for anterior shoulder instability?

What interventions are most common in this phase?

A

Stage 2-Intermediate Phase

Criteria to enter: reduced pain and improve motor control

Goal: reestablish muscle balance and restore full AROM

Interventions:

  • PROM and AAROM performed to the patient tolerance
  • IR/ER at 90 deg of ABD
  • Strength/stabilization at mid-range
18
Q

What is the criteria to enter phase 3 and what are the main goals of phase 3 of the rehab program for anterior shoulder instability?

What interventions are most common in this phase?

A

Phase 3-Advanced Strengthening Phase

Criteria to Enter:
minimal pain
-full ROM
-Symmetric capsular mobility
-Good strength (4/5 MMT)
-strength, endurance and dynamic stability of the scapulothoracic and UE regions

Goal-return to full daily activities (except sport) with an emphasis on strength and stability at end range of ROM

Interventions:

  • Low and high rep exercise (20-30 reps)
  • incorporation of co-contraction and dynamic stabilization
  • begin low intensity plyo exercise for the athlete returning to sport
19
Q

What are the main goals of phase 4 of the rehab program for anterior shoulder instability?

What interventions are most common in this phase?

A

Phase 4- Return to Activity Phase

Goal is to maintain full, functional and pain free ROM with an emphasis to perform strength program, dynamic stability and nueromuscular control

Interventions include sport specific activities w/ plyometrics, PNF and isotonic strengthening as it relates to the individual

20
Q

What exercises should be avoided in the acute and intermediate phases of shoulder instability rehab?

A

exercises that combine abduction and ER

21
Q

What 5 key components should patients gain from shoulder instability rehab?

A
  • flexibility
  • strength
  • balance
  • proprioception
  • Confidence

MSK 4 (14 decks)

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