Week 2: Shoulder Instability Flashcards

1
Q

How many people does shoulder instability affect?

A
  • As high as 2% of the population
  • 3x more common in men than women
  • Underestimate the true numbers, only include episodes of dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What enhances shoulder stability?

A
  • Labrum (bony congruency)
  • Negative pressure in GH joint
  • Muscle and tendons
  • Ligaments and capsule
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Differentiate b/t laxity and stability

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Instability classifications

A
  • Traumatic
  • Atraumatic
  • Acquired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is subluxation?

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is dislocation?

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bankart lesion

A

Tear of the glenoid labrum in anterior region of glenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Reverse Bankart lesion

A

Tear of the glenoid labrum in posterior region of the glenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hill-Sachs lesion

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reverse Hill-Sachs lesion

A

Compression fracture of the humeral head occurring as result of traumatic dislocation posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What part of the humerus is affected in a Hill-Sachs lesion?

A

Posterolateral humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What part of the humerus is affected in a reverse Hill-Sachs lesion?

A

Anteromedial humerus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What direction of instability is most common?

A
  • Anterior

- 90-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the characteristics of anterior instability?

A
  • Unidirectional w/ traumatic onset
  • ABD and ER
  • May have a Bankart lesion w/ it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How common is posterior instability?

A

2-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the characteristics of posterior instability?

A
  • Unidirectional w/ repetitive loading
  • ADD and IR
  • May have a reverse Bankart lesion w/ it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How common is multidirectional instability?

A

1-3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the characteristics of multidirectional instability?

A
  • Atraumatic

- Congenital or acquired laxity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Biceps tendon/SLAP lesions

A

May or may not be associated w/ GH instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What kind of traumatic MOI occurs with anterior dislocation?

A
  • Combo of abduction, extension, and posteriorly directed force on arm
  • Fall on an outstretched hand is common MOI for elderly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MOI for atraumatic injury to shoulder

A
  • Anatomical anomaly
  • General laxity
  • Poor muscle balance
  • Scapular dyskinesis
  • Connective tissue diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Scapular dyskinesis

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Connective tissue diseases of the shoulder

A
  • Ehlers-Danlos Syndrome

- Marfan Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ehlers-Danlos Syndrome

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Marfan Syndrome

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

MOI for acquired instability

A
  • Gradual development of laxity
  • Excessive ER
  • Posterior GH joint capsular tightness
  • Strength imbalance
27
Q

Clinical presentation for traumatic injury

A
  • Pain generalized to shoulder, but localize to the involved tissues
  • Apprehensive to moving arm out from body
28
Q

What factors does traumatic injury presentation depend on?

A
  • Etiology
  • Direction of instability
  • Severity
  • Frequency
29
Q

Clinical presentation for atraumatic injury

A
  • General multi-joint hypermobility
  • Loose inferior capsule
  • Atrophy of shoulder girdle
  • Dysfunctional movement patterns
30
Q

Clinical presentation for acquired instability

A

Combo of traumatic and atraumatic

31
Q

General principles to examine for instability

A
  • Observation
  • Pain/palpation
  • Movement
  • Strength
  • Sensation/proprioception
32
Q

Observation for examination of instability

A
  • “Protective” posture

- Presence of observable deformities, muscle atrophy

33
Q

Pain/palpation for examination of instability

A

Diffuse pain over anterior and posterior shoulder

34
Q

Movement for examination of instability

A

Unable/unwilling to move into end ranges

35
Q

Strength for examination of instability

A
  • Limited by pain, weak ABD and ER
  • Ability to co-activate dynamic stabilizers likely diminished
  • Check rotator cuff and scapular muscles
36
Q

Sensation/proprioception for examination of instability

A
  • Conduct sensory screen of shoulder complex

- Proprioception deficits may be noticeable

37
Q

Test item cluster for anterior instability

A
  • Apprehension test
  • Relocation test
  • Surprise test
  • Sp = 1.00
38
Q

Apprehension test

A

-

39
Q

Relocation test

A

-

40
Q

Surprise test

A

-

41
Q

Anterior drawer test for shoulder instability

A

-

42
Q

Special test for posterior instability

A

Jerk test

43
Q

Jerk test

A

-

44
Q

Special test for labral tear

A
  • Kim test

- Biceps load test II

45
Q

Kim test

A

-

46
Q

Biceps load test II

A

-

47
Q

Risks for recurring dislocations

A
  • Age-related
  • Gender
  • Fractures
48
Q

Age-related risks for recurring dislocations

A
  • 20s have 60% rate of recurrence

- 30s have 20% rate of recurrents

49
Q

Gender-related risks for recurring dislocations

A
  • 47% recurrence for men

- 27% recurrence for women

50
Q

Fractures and risks for recurring dislocations

A

Reduced risk of recurrence w/:

  • Boney Bankart
  • Greater tubercle fracture
51
Q

Key Factors for Consideration with Rehab of an unstable shoulder

A
  • Onset of instability
  • Degree of instability (subluxation vs dislocation)
  • Frequency of episodes
  • Direction of instability
  • Concomitant abnormalities/injuries
  • End-range neuromuscular control
  • Pre-morbid activity level
52
Q

Phases of non-operative management of anterior instability

A
  • Phase 1- Acute phase
  • Phase 2- Intermediate phase
  • Phase 3- Advanced strengthening
  • Phase 4- Return to activity
53
Q

Phase 1- Acute phase goals for non-operative management of anterior instability

A
  • Diminish 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 GH joint capsule
54
Q

Phase 1- Acute phase interventions for non-operative management of anterior instability

A
  • Immobilization
  • PROM- early motion in a protected range
  • Strengthening: submaximal, pain free isometrics
  • Dynamic stabilization
55
Q

Dynamic stabilization for acute phase

A
  • IR/ER in scapular plane
  • Flexion at 100 degrees, 10 degrees horizontal ADD
  • Closed kinetic chain
  • Scapular re-training
56
Q

Criteria to enter the intermediate phase of non-operative management

A

Reduced pain and improved motor control

57
Q

Goal of the intermediate phase of non-operative management

A

Reestablish muscle balance and restore full AROM

58
Q

Interventions for the intermediate phase of non-operative management

A
  • PROM and AAROM to patient tolerance
  • IR/ER at 90 degrees of ABD
  • Strength/stabilization in mid-range
59
Q

Criteria for entering the advanced strengthening phase of non-operative management

A
  • Minimal pain
  • Full ROM
  • Symmetric capsular mobility
  • Good strength (4.5 MMT)
  • Strength, endurance, and dynamic stability of the scapulothoracic and UE regions
60
Q

Focus of the advanced strengthening phase of non-operative management

A
  • Strength and dynamic stabilization at end range

- Return to full daily activities (not sport)

61
Q

Interventions for the advanced strengthening phase of non-operative management

A
  • Low and high repetition exercises (20-30 reps)
  • Co-contraction and dynamic stabilization
  • Low intensity plyometric exercise for return to sport
62
Q

Focus of the return to activity phase of non-operative management

A

Perform a strength program, dynamic stability, and NM control

63
Q

Goal of the return to activity phase of non-operative management

A

Maintain full, functional, and pain-free ROM

64
Q

Interventions of the return to activity phase of non-operative management

A

Sport specific activities w/ plyometrics, PNF, and isotonic strengthening