Glenohumeral Joint Dislocation Flashcards Preview

Tri 6 - MSK 2 > Glenohumeral Joint Dislocation > Flashcards

Flashcards in Glenohumeral Joint Dislocation Deck (33):
1

GH joint is what kind of joint

ball and socket, multidirectional

2

Function holds the tendon of the biceps brachii in place during GH movement

Transverse humeral ligament

3

most common before age

40

4

ligaments and capsule
give away

younger patients

5

can lead to an avulsion
fracture ie flap fracture

older patients

6

______ shoulder dislocations account for
approximately 95% of all acute shoulder dislocations

anterior

7

4 subtypes of shoulder dislocations

▪ sub-coracoid
▪ sub-clavicular
▪ sub-glenoid
▪ intrathoracic

8

primarily due to weakness of theRecurrent anterior shoulder dislocations are

middle and superior gleno-humeral ligaments
via: Foramen of Weitbrecht****

9

▪ caused by arm being forced into external
rotation and horizontal abduction with the
shoulder flexed to 90 degrees ▪ m/c in men 18-25

Anterior dislocation

10

falling on
outstretched arm ▪ Bilaterally with electric shock and epileptic
seizures
rare - 4%

posterior dislocation

11

▪ needs considerable vertical force of the
humerus
▪ usually associated with suprahumeral fracture

superior dislocation

12

▪ Severe Hyperabduction
trauma ▪ Humeral head contacts the
acromion which acts as a
fulcrum and forces the head
inferiorly ▪ Can remain locked in
hyperabduction

Inferior (Luxatio Erecta) dislocation

13

▪ anterior jt pain ▪ history of trauma ▪ interruption of normal shoulder contour with a
posterior bony prominence ▪ paresthesia / numbness in arm ▪ dead arm syndrome

anterior dislocation

14

▪ posterior shoulder pain ▪ most common sign - stuck in IR. No ER ▪ prominence of anterior acromium

posterior dislocation

15

patient’s arm
at side and doctor pulls down
on elbow while palpating GH
joint and feels increased
motion

sulcus test

16

Pt reaches across body, places hand on
opposite shoulder and pulls elbow towards chest. Dr
can apply A-P pressure on flexed elbow. Positive if
unable to finish test.

Dugas' test

17

adduction across
chest at 45 degrees and forward flexion at 90
degrees

Posterior Apprehension

18

(SLAP)

Superior Labrum Anterior to Posterior

19

Common in throwing athletes who present with a ▪ Mechanism - a crushing injury of the labrum between the humeral head and glenoid

SLAP lear

20

physical exam for SLAP

positive "clunk" test

21

typically you need what kind of image to spot SLAP tear

MRI w/ contrast

22

Fraying of the superior labrum with firm attachment of the labrum to the glenoid. Typically degenerative.

type 1 slap

23

Detachment of the superior labrum and the origin of the tendon of the long head of the biceps from the glenoid resulting in instability of the labral- biceps anchor

type II slap

24

Bucket-handle tear of the labrum with intact biceps insertion.

type III slap

25

Impaction fracture
of the humeral head on the
inferior glenoid rim. MRI is
extremely sensitive and
specific in locating lesion.

hill-sachs lesion

26

Avulsion
of the inferior glenoid rim at
the insertion of the triceps
muscle

bankart lesion

27

tx:
▪ gentle supported pendulum exercises
▪ Isometric exercises with arm at side
▪ Maintain fitness in other arm

Early post reduction (up to 3 weeks)

28

tx:
▪ Tubing exercises as tolerated
stim
▪ No abduction beyond 45 degrees
▪ no ER beyond neutral
▪ Increase proprioception/ sensory motor

Early capsular Healing (3-6 weeks)

29

tx:
beyond neutral or abduction beyond 90 degrees.
▪ Do not work end ROM unless stiff
▪ closed chain proprioception
▪ supervised resisted training, but not in ER

Intermediate Rehab

30

tx:
▪ Full ROM ▪ Plyometrics ▪ speed and endurance ▪ sport/ activity specific training

Final Rehab

31

Appropriate
weights (e.g., 5 pounds) are taped to the wrist of the dislocated shoulder which hangs free over the edge of the table.

Stimson's Technique

32

The surgeon stands on the side of the
dislocated shoulder near the patient's waist with the elbow of the dislocated shoulder bent to 90 degrees. A second sheet, tied loosely around the surgeon's waist and looped over the patient's forearm, provides traction while the surgeon leans back against the sheet while grasping the forearm. Steady traction along the axis of the arm usually causes reduction

Matsen's method (anterior reduction)

33

The heel does not go into the armpit but extends against the chest wall. The traction is slow and gentle. The arm may be gently rotated internally and externally to disengage the head of the humerus. The one pictured here uses a child to provide countertraction.

Hippocrates Technique