Instability

Question 1

joint instability is caused by? (3)

Answer 1

dislocations, sublux and soft tissue laxity

Question 2

occult joint instability (2)

Answer 2

Apparent only when the joint is stressed at end ranges, no substantial problems

Question 3

etiology of dislocations and subluxations (3)

Answer 3

congenital, traumatic, pathologic (result of RA, stroke, infection)

Question 4

joint laxity does not equal?

Answer 4

instability at the shoulder

Question 5

laxity is a quality?

Answer 5

that allows for full ROM

Question 6

what static structures provide stability to GH joint? (5)

Answer 6

negative pressure/labrum suction effect, cohesion-adhesion of synovial fluid, orientation of humeral head in glenoid fossa, tight superior GH cap and suprahumeral lig

Question 7

what dynamic structures provide stability to GH joint? (3)

Answer 7

RTC, long head of biceps and triceps

Question 8

rotator cuff and stability

Answer 8

provides a compression and positioning force

Question 9

long head of biceps and stability

Answer 9

stabilizes GH joint during overhead throwing

Question 10

long head of triceps and stability

Answer 10

stabilizes against inf trans

Question 11

causes of joint instability (4)

Answer 11

trauma (falls, sports), epileptic convulsions, atraumatic/involuntary, voluntary

Question 12

atraumatic/involuntary shoulder instability (3)

Answer 12

Pain/instability with activity, no history of trauma, insidious onset from repetitive micro trauma

Question 13

what are the major categories of shoulder instability? (2)

Answer 13

AMBRI and TUBS

Question 14

AMBRI (born loose) (5)

Answer 14

Atraumatic, Multidirectional instability, B/L (asymptomatic shoulder is also loose), Rehab is the treatment of choice, Inf cap shift if conservative care fails

Question 15

TUBS (torn loose)

Answer 15

Traumatic, Unidirectional, Bankart, Surgery

Question 16

anterior shoulder dislocation (3)

Answer 16

forced Abd/ER or elevation

Question 17

incidence of anterior shoulder dislocations (4)

Answer 17

collision sports, accidents, falls, has a HIGH recurrent rate (young males)

Question 18

associated lesions following an anterior shoulder dislocation? (6)

Answer 18

bankart (most common), hills-sachs, fractured glenoid, ruptured subscap, greater tuberosity fx, axillary nerve injury

Question 19

bankart lesion

Answer 19

tearing of the ant inf portion of the labrum (4-6)

Question 20

hills-sachs lesion

Answer 20

Compression fx of the posterolateral humeral head from impacting the ant inf glenoid rim

Question 21

signs/symptoms of anterior shoulder dislocation (4)

Answer 21

pain, unable to use arm, square appearance of the shoulder, prominent acromion

Question 22

complications of anterior shoulder dislocations (3)

Answer 22

Axillary artery or nerve injury (brachial plexopathy), RTC

Question 23

acute treatment of anterior shoulder dislocations (4)

Answer 23

Closed reduction via traction with countertraction, x rays, modalities and meds to control pain/inflammation, immobilized in slight IR

Question 24

rehab outcomes for anterior shoulder dislocations (4)

Answer 24

Restore structural flex and strengthen stabilizers, Prevent shoulder dysfunction, Prevent recurrence of dislocation, Return to work/sports/ADL without limitations

Question 25

PT Goals and expected outcomes for anterior shoulder dislocations (4)

Answer 25

increase strength of RTC muscles (IR/ER/add), correct scap/hum rhythm, restore proprioception (through alternating isometrics) and functional use of extremity

Question 26

precautions following anterior shoulder dislocation surgery (3)

Answer 26

Limit ER, horiz abd and ext for first six wks

Question 27

What muscles to strengthen for anterior shoulder instability (3)

Answer 27

IR and add to support ant cap, ER to stabilize humeral head

Question 28

MOI for posterior shoulder dislocations (3)

Answer 28

Fall on front of the shoulder, fall on hand with shoulder add and IR, direct force against lower end of humerus with arm flexed

Question 29

signs/symptoms for posterior shoulder dislocation (3)

Answer 29

pain, no gross deformity, shoulder may be locked in add/IR/unable to ER

Question 30

posterior shoulder dislocations are commonly seen in?

Answer 30

alcoholics

Question 31

complications of posterior shoulder dislocations (3)

Answer 31

Reverse Hill-Sachs lesion, Fx of post glenoid rim, Lesser tuberosity fx

Question 32

reverse hill-sachs lesion

Answer 32

Hatchet shaped-defect in anteromedial humeral head

Question 33

reverse Bankart lesion

Answer 33

fx of posterior glenoid rim

Question 34

what muscles need to be strengthened to help posterior aspects of shoulder joint? (4)

Answer 34

RTC, post delt, lats, long head of triceps

Question 35

what activities should be avoided with a posterior shoulder dislocation? (3)

Answer 35

Avoid position of flex with add and IR, Posterior glide is contraindicated

Question 36

inferior dislocation of shoulder (3)

Answer 36

arm is forced into abd, lat neck of humerus impinges on acromion, humeral head is forced inf and slips out of glenoid fossa

Question 37

secondary injuries of a inferior dislocation (3)

Answer 37

inf cap damaged, inf GH ligament tear, glenoid labrum fx

Question 38

Multidirectional Instability (3)

Answer 38

Patient displays hypermobility of multiple joints, typically congenital (AMBRI), treatment is typically conservative

Question 39

treatment for voluntary dislocation (3)

Answer 39

Exercise to enhance shoulder stability & prioprioception, Education to reduce dislocations, Biofeedback for post delt

Question 40

anterior subluxation (3)

Answer 40

Dead arm syndrome (seen in athletes), excessive abd and ER, sudden pain and weakness

Question 41

posterior subluxations

Answer 41

uncommon

Question 42

inferior subluxations (3)

Answer 42

Positive sulcus sign, weakness of RTC, common following CVA with hemiparesis

Question 43

MOI of AC joint separation (3)

Answer 43

Severe fall on top of shoulder, injury to AC and coracoclavicular ligaments

Question 44

diagnosis for AC joint separation (2)

Answer 44

X-ray with pt standing holding a weight in each hand, will see a step

Question 45

treatment for AC joint separation (4)

Answer 45

sling, strapping, casting, surgery