Shoulder laxity

Question 1

Instability vs laxity

Answer 1

-Instability= Symptomatic laxity of the GHJ

Laxity- symptom free

Question 2

Unilateral vs multidirectional instability of the GHJ

Answer 2

Unidirectional-
-traumatic etiology typically.
-Symptomatic when arm placed in area of injury
-Typically responds well to surgical
Multidirectional
-No acute trauma
-Unstable in multiple directions
-Typically does well with rehab
- capsular shift surgery as needed

Question 3

Hypermobility syndromes

Answer 3

Ehrler’s danlos
Marfan’s
Loeys-Dietz
Stickler syndrome

Question 4

Hypermobility spectrum disorders have symptoms of

Answer 4

Recurrent soft tissue injuries
CHronic widespread pain
Declining physical capacity
Anxiety
Systemic concerns- CV and bowel

Question 5

Indications for diagnostic evaluation for EDS

Answer 5

elevated beighton hypermobility score 4 or more of 9
Historic evidence of joint hypermobility

Question 6

Multidirectional instability common population

Answer 6

More common in sedentary young women with poor muscle development
-patients with RCT
-Hypermobile patients
-Athletes- gymnasts, dancers, tennis players and throwers

Question 7

Swimmers and laxity

Answer 7

Varied findings

Question 8

Clinical presentation of multidirectional instability

Answer 8

anterolateral pain
SHoulder looseness “giving way”
Noisy- popping and clicking
Transient N/T/weakness
Usually not one event
History of overuse/fatigue causing events

Question 9

What form of instability ?

Feeling shoulder will dislocate when throwing

Symptoms when lifting heavy object

REcurrent dislocations while sleeping

Answer 9

• Anterior instability

inferior instability

Severely decompensated shoulder

Question 10

What is normal GH rhythym

Answer 10

2:1 once past 20 degrees

Question 11

Special tests for shoulder instability

Answer 11

Sulcus sign= + of 2cm or more. .5-1 = normal

APprehension, relocation and release tests (85% sensitivity, 87% specifity)

Load and shift test

Jerk

HERI

Question 12

Sulcus sign performed how

Answer 12

in neutral

THen in External rotation- if more motion- RC interval to be examined

Question 13

Load and shift test

Answer 13

Scapula stabilized and humeral head compressed and anterior and posterior force

Supine and sitting

Question 14

Posterior instability tests

Answer 14

JERK

Question 15

HERI test

Answer 15

Tests anterior instability

No apprehension with test
doesn’t risk dislocation

difference of greater than 10= +

Question 16

Multidirectional instability exercise vs surgery

Answer 16

Surgery > exercise for impairment

Exercise >surgery for Patient reported outcome measure

Question 17

Multidirectional instability program which exercise group did best in RCT

Answer 17

Watson group= 12 weekly sessions improved better at 12 and 24 weeks

Question 18

Watson multidirectional stability program

Answer 18

6 stage program- focused on maintaining scapular and humeral head control

Stage 1- scapular control at 0-30 abduction

Stage 2 posterior musculature development
Stage 3 flexion control 0-45
Stage 4- flecion and abduction control to 90
Stage 5- deltoid strengthening
Stage 6 sport specific

Question 19

Poor outcomes for MDI with factors of

Answer 19

trauma
Overhead sport athletes
Voluntary dislocators

Question 20

Surgery indicated for

Answer 20

persistent pain
Recurrent dislocation
Unilateral instability
Connective tissue disorders