Shoulder Dislocation and Instability Flashcards Preview

724: Medical Lectures > Shoulder Dislocation and Instability > Flashcards

Flashcards in Shoulder Dislocation and Instability Deck (29)
1

95% of the shoulder dislocations/instability occur in what direction?

anterior

2

What are the 3 most typical MOIs for an anterior dislocation?

- blow to the abducted, externally rotated, and extended arm (blocking a basketball shot)
- blow to the posterior humerus
- fall on an outstretched and abducted arm

3

Patients with an anterior dislocation typical complain of pain and a feeling of instability when the arm is in what position?

abducted and externally rotated

4

What are the 3 most typical MOIs for a posterior dislocation?

- falls from height
- violent muscle contraction due to epileptic seizures or electric shocks
- blow to the anterior shoulder

5

What are the 2 most typical MOIs for an inferior dislocation?

- axial loading with the arm fully abducted or forceful hyperabduction of the arm
- during a fall and suddenly grasping onto an object above their head resulting in hyperabduction

6

What can traumatic shoulder dislocation lead to?

instability

7

What is the rate of repeated dislocation directly related to?

patient's age

8

What other injury is found in 90% of young active patients with traumatic shoulder dislocation?

labral injuries often described as Bankart lesions when the anterior inferior labrum is torn

9

What are the associated injuries in older patents (55+)?

rotator cuff tears or fractures

10

What are atraumatic shoulder dislocations usually caused by?

intrinsic ligament laxity or repetitive microtrauma leading to joint instability

11

In what patient populations are atraumatic shoulder dislocation common?

in overhead and throwing sports, such as swimmers, gymnasts, and pitchers

12

In what position do patients following shoulder dislocation hold their arm?

in an externally rotated position

13

What typically improves pain and deformity?

manual relocation

14

Why are posterior dislocation often missed?

because the patient usually holds the shoulder and arm in an internally rotated position, which makes the shoulder deformity less obvious

15

What do posterior dislocation patients complain of not being able to do functionally?

push open a door

16

What are 3 stability tests that can be performed to help diagnose?

- apprehension test
- load and shift test
- O'Brien's test

17

What are the 3 standard radiographic views?

- AP
- axillary
- orthogonal

18

Why are orthogonal views used?

to identify a posterior shoulder dislocation, which can be missed easily with the AP view of the shoulder

19

What type of fracture is associated with an anterior shoulder dislocation?

indented compression fractures at the posterior-superior part of the humeral head

20

What are 2 other imaging techniques that can help identify labral and ligamentous involvement?

- MRI
- MRI anthrogram

21

Hill Sachs lesions occur in __-__% of anterior dislocations

35-40

22

When do Bankart lesions form?

when the glenoid is disrupted with dislocation

23

What is the recommended treatment for acute dislocations?

reduction ASAP

24

What are the 2 types of reduction maneuvers?

- Stimson procedure
- Traction Countertraction procedure

25

Following reduction of an acute dislocation what is the rehab protocol?

- sling immobilization for 2–4 weeks along with pendulum exercises
- early physical therapy

26

If a "TUB" is the clinical diagnosis surgery is often required. What does TUB stand for?

Traumatic incident
Unilateral shoulder dislocation
Bankart lesion

27

What is the rehab protocol for atraumatic chronic shoulder instability?

Physical therapy and a regular maintenance program, consisting of scapular stabilization and postural and rotator cuff strengthening exercises

28

If an "AMBRI" is the clinical diagnosis surgery is often not required. What does AMBRI stand for?

Atraumatic
Multidirectional
Bilateral instability
Rehabilitation is the mainstay for treatment
Inferior capsular shift surgery is rarely required

29

When should you refer?

- Patients who are at risk for second dislocation, such as young patients, certain jobholders (eg, police officers, fire fighters, and rock climbers) to avoid recurrent dislocation or dislocation while at work.
- Patients who have not responded to conservative approach or who have chronic instability.