Ortho: Shoulder Instability

Front 1

What stabilizes the head of the humerus in the glenoid?

Back 1

*Capsule
*Ligaments
*Muscles (RCM)
*Labrum
*negative pressure in the capsule

Front 2

What position is the arm often in during a traumatic dislocation of the humerus?

Back 2

abduction and ER

Front 3

What position is the arm in after a traumatic dislocation of the humerus?

Back 3

adducted and IR

Front 4

Where does the head of the humerus go when anteriorly dislocated?

Back 4

it takes a subcoracoid location

Front 5

What is the MOI for a traumatic humeral dislocation?

Back 5

FOOSH (fall on outstretched hand)

** Can be anterior or posterior

Front 6

What part of the labrum is affected by a Bankart lesion?

Back 6

anterior/inferior labrum

Front 7

Define TUBS

Back 7

traumatic unidirectional (most likely anterior) Bankart lesion
(and usually requires) surgery

Front 8

What other structures could be damaged in a humeral dislocation?

Back 8

*Superior Labrum
*Hill-Sachs lesion
*Rotator Cuff Tears
*Nerve Injuries
*Blood vessels

Front 9

What is disrupted in the joint during a humeral dislocation?

(many things, but I'm only looking for one specifically)

Back 9

negative pressure causing the joint to be unstable

Front 10

Define SLAP

Back 10

superior labrum anterior and/or posterior

Front 11

Where does a SLAP tear or lesion occur?

Back 11

where the biceps tendon anchors to the labrum

Front 12

What is the difference between a Bankart and SLAP lesion?

Back 12

The location.

Bankart is at the anterior inferior portion of the labrum while SLAP is at the superior portion and can be either anterior or posterior.

Front 13

Briefly differentiate between the 4 types of SLAP lesions.

Back 13

Type 1 -- tear at biceps tendon
Type 2 -- separate
Type 3 -- a flap is hanging down
Type 4 -- flap with a biceps tendon tear

** 1 is the lightest injury while 4 is heavy

Front 14

What is reduction?

Back 14

fixing a dislocation

Front 15

What is a Hill-Sachs lesion?

Back 15

A complication of a shoulder dislocation -- an anterior dislocation with the anterior glenoid rim indenting the posteriolateral part of the humeral head

Front 16

What side of the humeral head is usually damaged in a Hill-Sachs lesion?

Back 16

posterior side

Front 17

What is the term for "compression fracture of the head of the humerus"?

Back 17

Hill-Sachs lesion

Front 18

What motion is unstable after reduction of a Hill-Sachs lesion?

Back 18

ER

Front 19

What set of muscles can be torn as a result of a shoulder dislocation?

Back 19

RCM

Front 20

What nerve could potentially be injured as a result of a shoulder dislocation?

Back 20

axillary nerve -- with anterior dislocations the subscapularis is displaced forward, and this creates a traction injury to the axillary nerve

Front 21

What space does the axillary nerve come through?

Back 21

Quadrangular space

Front 22

What are the borders of the quadrangular space?

Back 22

humerus, teres minor, teres major, and long head of triceps

Front 23

How does the axillary nerve wrap around the humerus that sets it up for injury in the case of a dislocation?

Back 23

axillary nerve wraps around behind along the neck of the humerus -- so in an anterior dislocation it is trapped

Front 24

What age group is at risk for vessel injuries during a shoulder dislocation and why?

Back 24

older population because of decreased elasticity of the vessels

Front 25

What are Sxs of an axillary nerve injury?

Back 25

loss of sensation and deltoid strength

Front 26

What is the MOI for atraumatic recurrent instability?

Back 26

people who get this have no previous (or a minor) history of injury, generally they are born loose or are hypermobile

Front 27

Define AMBRI

Back 27

atraumatic multidirectional bilateral, rehab, inferior capular shift

Front 28

What are the 3 key tests for anterior instability?

Back 28

*Load and Shift
*Anterior (crank) Apprehension
*Jobe subluxation/relocation

Front 29

What is the test for multidirectional/inferior shoulder instability?

Back 29

*Sulcus sign

Front 30

What are the 3 main tests for posterior shoulder instability?

Back 30

*Posterior apprehension
*Push and Pull
*Jerk

Front 31

What is the most important thing to check when looking at radiographs?

Back 31

normal alignment and disruptions

Front 32

How is a Bankart lesion usually treated?

Back 32

with surgery

Front 33

What is the conservative approach to instability?

Back 33

immobilization

Front 34

How long is a young person immobilized for instability?

Why?

Back 34

6-8 weeks, to allow them to tighten up and to limit them

Front 35

How long is an older person immobized for instability?

Why?

Back 35

2-3 weeks, to keep them from developing adhesions

Front 36

In a conservative approach to treating immobilization, how long is the patient allowed only controlled motion? (PROM/AROM and isometrics)

Back 36

2-5 weeks

Front 37

With instability what movements should we initially avoid?

Back 37

ER past neutral (go from internal rotation to neutral), extention (stresses anterior capsule), ER with abduction, anterior gliding

Front 38

What can we do with patients who are in the early stages of instability treatments?

Back 38

active and passive motions with care, isometric and dynamic strength

Front 39

What position is the arm in during a posterior shoulder dislocation?

Back 39

force applied that combines flexion, adduction and internal rotation (can occur through a FOOSH

Front 40

Where does the humeral head end up in a posterior dislocation?

Back 40

usually subacromial, can also be subglenoid or subspinous