Glenohumeral Joint Dislocation

Question 1

GH joint is what kind of joint

Answer 1

ball and socket, multidirectional

Question 2

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

Answer 2

Transverse humeral ligament

Question 3

most common before age

Answer 3

40

Question 4

ligaments and capsule

give away

Answer 4

younger patients

Question 5

can lead to an avulsion

fracture ie flap fracture

Answer 5

older patients

Question 6

______ shoulder dislocations account for

approximately 95% of all acute shoulder dislocations

Answer 6

anterior

Question 7

4 subtypes of shoulder dislocations

Answer 7

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

Question 8

primarily due to weakness of theRecurrent anterior shoulder dislocations are

Answer 8

middle and superior gleno-humeral ligaments

via: Foramen of Weitbrecht**

Question 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

Answer 9

Anterior dislocation

Question 10

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

Answer 10

posterior dislocation

Question 11

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

Answer 11

superior dislocation

Question 12

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

Answer 12

Inferior (Luxatio Erecta) dislocation

Question 13

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

Answer 13

anterior dislocation

Question 14

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

Answer 14

posterior dislocation

Question 15

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

Answer 15

sulcus test

Question 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.

Answer 16

Dugas’ test

Question 17

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

Answer 17

Posterior Apprehension

Question 18

(SLAP)

Answer 18

Superior Labrum Anterior to Posterior

Question 19

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

Answer 19

SLAP lear

Question 20

physical exam for SLAP

Answer 20

positive “clunk” test

Question 21

typically you need what kind of image to spot SLAP tear

Answer 21

MRI w/ contrast

Question 22

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

Answer 22

type 1 slap

Question 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

Answer 23

type II slap

Question 24

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

Answer 24

type III slap

Question 25

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

Answer 25

hill-sachs lesion

Question 26

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

Answer 26

bankart lesion

Question 27

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

Answer 27

Early post reduction (up to 3 weeks)

Question 28

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

Answer 28

Early capsular Healing (3-6 weeks)

Question 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

Answer 29

Intermediate Rehab

Question 30

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

Answer 30

Final Rehab

Question 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.

Answer 31

Stimson's Technique

Question 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

Answer 32

Matsen's method (anterior reduction)

Question 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.

Answer 33

Hippocrates Technique