Dislocation - Proximal Humeral Apophysitis - Exam 3 Flashcards
what joint is the most dislocated?
GH jt
what is the most common direction a dislocation happens? mechanism?
anterior - ant/inf direction
ER and ABD with FOOSH
how would a posterior dislocation happen?
90 deg flexion with FOOSH
what structures are involved with a dislocation?
stretch, tear capsule, ligament
other possible damage:
- anterior labrum tear (Bankart lesion, anterior movement of humeral head)
- SLAP lesion
compare fibrocartilage vs articular cartilage
thicker and concave
- outer portion is thick
- inner portion is thin
- widens and deepens joint surface
what locations are where fibrocartilage is a dominant tissue?
shoulder and hip labrum
SC, tibiofemoral, AC, ulnotriquetral, intervertebral, pubic symphasis
in fibrocartilage, outer collagen is primarily what type? what does it do?
type I collagen
resists tension for stabilization
majority type in ALL fibrocartilage
in fibrocartilage, inner collagen is secondarily what type? what does it do?
type II, III, IV collagen
resists compression for shock absorption
fibrocartilage is like what other structure we have learned about?
annulus –> outer type I, inner type II
the outer fibrocartilage is what kind of tissue?
vascular and neural tissue
neural attributes for proprioception/kinesthesia like ligament/annulus for stabilization
the inner fibrocartilage is what kind of tissue?
hypo- or avascular/aneural/alymphatic (resist compression)
what happens to fibrocartilage after trauma?
tears possibly with RC tear/dislocations
why is fibrocartilage better at periphery healing?
due to greater vascularity
tensile strength initially improves at _______ weeks
greater tensile strength improves when dense fibrous tissue fills in at ______ weeks
3-5 weeks
8-12 weeks
what would your MET be focused on for fibrocartilage Rx?
tissue integrity/proliferation with vascularity issues
stabilization due to stabilizing role of fibrocartilage
what other damage could occur with dislocation?
fracture aka Hill Sachs Lesion - compression fracture of humeral head
RC tears
neurovascular structures
what are symptoms of dislocation?
trauma in characteristic position
acute presentation
what would the scan findings be for dislocation?
ROM?
resisted/MMT?
stress tests?
- limited and painful most directions
- weak and painful most directions
- likely (+) depending on structure involved
what are possible (+) tests for labrum dislocation? fracture dislocation?
labrum dislocation:
anterior instability
anterior labrum
postero-inf labrum
SLAP
fracture dislocation:
olecranon-manubrium percussion test
bony apprehension test (Bankart or Hill-Sachs)
what is the main prescription for dislocations?
immobilization & POLICED
- up to 6 weeks
- improve rotator cuff activation with contralateral UE use and ipsilateral hand squeezing activities
- shorter periods are favored
What would MET focus on for dislocations?
stabilization
tissue integrity and proliferation
for an anterior dislocation, which motions should you check to be ok first? Why?
which motions are initially contra-indicated?
IR, EXT, ADD
These directions are opposite of the painful motions from a dislocation
contraindicated: ER, FLX, ABD
why would you perform isometrics and isotonics into opposite directions initially for an anterior dislocation?
start away from direction that is hurt
sensitive spindle to make aware of muscle contraction
what is the prognosis for a dislocation? recurrent dislocations are highly likely if patient is < ______ years?
not all injuries are the same so healing time is not always the same
< 30 years
