Shoulder instability

Question 1

What features contribute to shoulder stability (anatomy)

Answer 1

• Labrum: deepens socket - Articular -Cartilage thinner thicker peripheral
  capsule/ligaments
• Musculature
• Synovial fluid - cohesion
• Negative intra articular pressure
• Slight tilt of glenoid fossa - lost with rounded shoulders
• Narrow glenoid fossa = more instability

Question 2

how can translation influence instability

Answer 2

• Translation: movement of humerus on glenoid
• instability: symptoms associated with unwanted translation

Question 3

circle of stability

Answer 3

• Since the capsule is round is stretches on both sides of the head

Question 4

Degree of instability

Answer 4

• had the jt dislocated or subluxed before

Question 5

-Nature of the shoulder instability

Answer 5

• Did we have an acquired laxity: dislocation or sublux
• Congenital: poor collagen, disease that affects
• Repetitive motions

Question 6

Classifications of shoulder instability

Answer 6

• TUBS: traumatic Unilateral/Unidirectional Bankart Lesion Surgery
• AMBRI: Atraumatic Multidirectional Bilateral Rehab Inferior capsular shift
  Responds well to rehab

Question 7

GH translation grades

Answer 7

• humeral translation:
• Grade 0: none/no translation
• Grade 1: mild/humeral head moves slightly up face of glenoid
• Grade 2: moderate/humeral head rides up glenoid face to but not over the rim
• Grade 3: severe/humeral head rides up and over the glenoid rim
  Usually reduces when stress removed
  May remain dislocated when stress removed (rare)

Question 8

Translation for the GH joint norms
- posterior
- inferior
- anterior

Answer 8

• Posterior translation: normal = 3-20 mm; ½ width of head
• Inferior translation: 5-15 mm
• Anterior translation: 2-13 mm; normal ¼ width of head

Question 9

Mechanism of shoulder instability

Answer 9

• traumatic
• atraumatic
• overuse

Question 10

Traumatic mechanism of shoulder instability

Answer 10

• 90º of Abduction and ER with Habduction = most common dislocation
• Can dislocate posterior but must land on an outstretched hand in IR

Question 11

Atraumatic mechanism of shoulder instability

Answer 11

• 5% of dislocation
• AMBRI

Question 12

Associated conditions with shoulder instability

Answer 12

• Bankart lesion: anterior inferior tear in labrum
• Hills sachs lesion: impaction fracture from an anterior dislocation
• HAGL lesion: humeral avulsion glenoid ligament
• Axillary Nerve injury: damaged with dislocation at times

Question 13

Management trends with immobilization after dislocation

Answer 13

• Study that looked immobilization times: 1 week vs 4 weeks
• 10 years 50% in both groups recurrence
• 25 years: both groups had changes

Question 14

Age management trends with shoulder dislocations

Answer 14

• Should you do surgery for younger people to increase stability
• Under 30 they immobilize longer to protect from themselves (usually more than 3 weeks
• Over 30 they immobilize 1-2 weeks

Question 15

Position of immobilization in management trends for shoulder dislocation

Answer 15

• does not affect healing

Question 16

TUBS: managment in protective phase

Answer 16

• activity restriction 6-8 weeks
• Protected ROM: Against motion they dislocated (go slow into ABD/ER)
• Isometrics: Turn muscles on with Submax isometrics
• By 6 weeks increase to 40-45º of ER

Question 17

TUBS: management in controlled motion phase goals

Answer 17

• Increase shoulder mobility
• Increase stability and strength

Question 18

Return to function phase TUBS management

Answer 18

• Strength balance: pec major, lats, teres major
  *Need to coordinate endurance and call on muscles when needed
  *Propception to tell when those muscle need to turn on
• Coordination of shoulder and scapula
• Endurance: proprioception thrown off with fatigue
• Eccentric training
• Increasing speed and control
• Stimulating functional movements

Question 19

Return to maximal function phase TUBS management

Answer 19

• typically for excessive sports esp with throwing
• usually rehab is 10-16 weeks if they are returning to these sports

Question 20

AMBRI management

Answer 20

• Usually have accommodate to increased laxity
• Identify specific movement impairments at the GH and ST joints
• Re-establish active control using manual cues and beginning with limited motion
• Gradually increase: range of active control, endurance, strength and complexity of movement
• 6 phase program