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64 Cards in this Set
- Front
- Back
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shoulder instability factors
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young population, hypermobililty
microtraumatic |
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microtraumatic at AC joint
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low load over time
AC instability from poor ST control weakness in ST joint |
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where do you typically land for it to be AC?
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on the shoulder
GH is landing on the arm |
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macrotraumatic at AC joint
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fall by driving acromion back
named by involvement of the ligaments 1,2,3,4,5,6 |
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AC instability
test of function |
painful to reach OH when clavicle rotates (most tension or stress)
or cross-body reach; forced to overlap each other which is painful |
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AC joint
P/A |
intraarticular?
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AC joint
ROM |
no loss of PROM but loss of AROM
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AC joint
Joint play |
painful at grade 1
above that can be empty, painful, and hypermobile in any direction you test in |
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AC joint
Muscle performance MMT |
will be very weak
performance usually impaired by pain |
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conservative treatment
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immobilize, depending on person, sling for 3-5 days
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AC joint
what to avoid |
avoid anything OH past 90 or crossbody adduction
-protect the joint early, then you want mobility and strength |
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GH instability
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can be capsligs
labral AC separation |
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what is instability
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excess motion accompanied by pain when you lift the arm
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GH micro instability
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ligs caps
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GH macro instability
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tear of labrum
dislocation (AC separation) |
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GH instability
anterior band of GH lig |
aBduction and ER greater than 45 deg of elevation
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GH instability
superior GH lig/CH lig |
head goes down
inferior dislocation |
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GH instability
middle GH lig |
under 45 degrees of elevation
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GH instability
labrum |
provides compression, increases congruency btw joint and humeral head
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static stabilizers of GH
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labrum, sup, middle, infr GH lig create passive restraint, bony (poor),
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GH ligaments
superior GH limits |
anterior and inferior humeral translation w/ arm at side
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GH ligs
middle GH limits |
anterior humeral translation with arm at side and up to 45 aB
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GH ligs
inferior GH limits |
aB beyond 45 (anterior band limits trans ER)
and (posterior band limits trans IR) |
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instability injuries cause major issues with
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delayed firing
causing head shearing and accuracy problems loss of proprioception |
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GH
test of function |
tell you when most stressed position they dont want to be in
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GH instability
P/A |
could be intraarticular or extraarticular (ligament)
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GH instability
ROM |
can be excessive
or apprehension can lower it |
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GH instability
Joint Play |
can be excessive or limited
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GH instability
proprioception/kinesthesia |
above 10 degree difference is a deficit
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GH instability
MMT |
??
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GH instability
selective tissue tests |
SLAP, resisted supination, ER test
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GH anterior
anatomy |
capsule
GH lig dep on position |
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GH anterior
mechanism of injury |
BLOW to arm in aB and ER, FOOSH, heavy labor
overhead sport |
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GH anterior
symptom |
pain, giving away, dead arm, inability to reach OH
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Gh anterior
exam findings |
P/A extraarticular
maybe increase in ROM/ER increased Joint play -apprehension test + |
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GH anterior
prognosis/diagnosis |
likely to get OA if humeral head dislocates
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GH anterior ROM
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ER and extension are excess??
cannot do aB or ER? |
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GH inferior
anatomy |
SGHL, CH lig, supraspinaturs, inferior labrum
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GH inferior
mechanism of injury |
heavy load at arm at side
FOOSH with OH (gymnist) |
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GH inferior
symptoms |
pain, giving away, inability to carry things down at her side
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GH inferior
examination findings |
P/A: extraarticular
maybe increase aBduction -sulcus sign |
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GH inferior ROM
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aBduction and flexion are excess
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GH posterior
anatomy |
post band of IGHL
posterior capsule |
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GH posterior
mechanism of injury |
FOOSH with arm in flex, hor add, IR (think push up)
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GH posterior
symptoms |
pain, giving away, inability to push open doors
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GH posterior
exam findings |
PA extraarticular
maybe increased IR + posterior apprehension |
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GH posterior
ROM |
excess in IR and
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GH multidirectional
anatomy |
all
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GH multi
mechanism of injury |
generalized joint laxity
high demand laborer |
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gh multi
exam findings |
capable of independent subluxation
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injuries associated with instability
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SLAP lesiosn
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SLAP lesion
I |
degeneration, fraying but no pulling away
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slap lesion
II |
degeneration, frayed, and pulled off
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slap lesion
III |
macro trauma
bucket handle teraing |
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slap lesion
IV |
macro, tears off and pulls part of biceps tendon with it
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instability
Goals |
protect the joint and pt ed
mobility and provide co-contraction to compress humeral head |
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type of exercise for labrum
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intermittent compression
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type of exercise for ligaments
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intermittent shear,
as ligament heals then you ROM |
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young males v. older females
ligaments |
younger males you want to stiffen and thus you hold back
older females: don't even sling them, they are already stiff |
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ligaments
ther ex |
scapula stability is huge
co-contraction at the joint use a swiss ball and prone lying for ST control |
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ligaments ther ex
close chain |
promotes stability but if you have labral tear not the best choice
-not very functional, so do open chain, endurance activities help with instability because it stiffens capsule |
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ligaments
ther ex early |
squeezing a ball creating contraction
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ligaments
ther ex later |
dowel against a wall for isometrics
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ligaments
therabands |
when actual tension on band, we are tensing muscles but resting cuff (ligs and capsule)
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