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Ortho Exam 2 > Shoulder Instability > Flashcards

Shoulder Instability Flashcards

(80 cards)

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1
Q

which joint is most likely to be hypermobile

A

GH joint

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2
Q

rate of primary dislocation overall

A

3:1 male to female

9:1 in the 21-30 yo group

3:1 female to male in the 60-80 yo group

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3
Q

reoccurance

A

80-95% in young adults

10-15% age > 45 yo

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4
Q

MOI

A

traumatic

atraumatic

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5
Q

traumatic –> MOI

A

majority of cases

severe pain

deformity

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6
Q

traumatic injury

A

anterior and posterior dislocation

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7
Q

trauma forces arm –> anterior dislocation

A

into ER and ABD (90/90 position)

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8
Q

% of all traumatic dislocation –> anterior dislocation

A

95%

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9
Q

immediately post trauma –> anterior dislocation

A

arm positioned in slight ABD and ER

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10
Q

trauma forces arm –> posterior dislocation

A

directly posterior

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11
Q

% of all traumatic dislocations –> posterior dislocation

A

5%

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12
Q

classic –> posterior dislocation

A

steering wheel injury

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13
Q

immediately post trauma –> posterior dislocation

A

arm positioned in ADD and IR

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14
Q

why should reduction be done ASAP

A

due to increased pain

potential vascular supply injury

potential injury to thoracic outlet structures

soft tissue response

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15
Q

usually –> Atraumatic

A

multidirectional instability

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16
Q

what cant stabilize the joint –> Atraumatic

A

bony structures

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17
Q

what does the pt have –> Atraumatic

A

severe ligamentous laxity

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18
Q

what does atraumatic create

A

chronic fatigue (overuse) of muscles

prolonged microtrauma

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19
Q

normal stability components

A

bone

capsuloligamentous (static)

muscular (dynamic)

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20
Q

movement

A

primary or secondary

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21
Q

primary movement

A

side of translation

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22
Q

secondary movement

A

side opposite of translation

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23
Q

bony stability

A

coracoacromial arch

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24
Q

muscular stability

A

LHB

RC

scapular stabilizers

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25
capsuloligamentous stability
capsule capsular GH ligs
26
grading anterior stability
grades 1-3
27
grade 1 --> anterior stability
25-50% translation w/o dislocation
28
grade 2 --> anterior stability
>50% translation dislocation w/ spontaneous reduction
29
grade 3 --> anterior stability
>50% dislocation w/o reduction
30
classification system
FEDS classification
31
FEDS
frequency etiology direction severity
32
frequency --> FEDS
solitary = 1 episode occasional = 2-3 episodes frequent >5 times
33
etiology --> FEDS
traumatic atraumatic
34
direction --> FEDS
anterior (out the front, most common) posterior (out the back, 2nd most common) inferior (out the bottom, least common)
35
severity --> FEDS
did you need to help relocate the shoulder? dislocation? subluxation?
36
the examination
CHARTS
37
C --> CHARTS
pain instability
38
H --> CHARTS
FEDS MOI magnitude of force
39
A --> CHARTS
humeral head position postural components palpation
40
humeral head position --> CHARTS
observation
41
observation --> CHARTS
anterior &/or inferior to acromion acromion is prominent shoulder appears square
42
palpation --> CHARTS
feel for position of humeral head and clavicle usually tenderness at insertion of anterior and inferior GH ligs
43
R --> CHARTS
AROM PROM accessory ROM resistive ROM
44
AROM --> CHARTS
acute and chronic
45
acute AROM --> CHARTS
usually decreased w/ apprehension and guarding pain esp movements in which anterior capsule is stretched
46
chronic AROM --> CHARTS
excessive
47
PROM
acute and chronic
48
acute PROM --> CHARTS
decreased ER especially @ 90 ABD
49
accessory ROM --> CHARTS
expect anterior capsule laxity and posterior capsule tightness
50
T --> CHARTS
tone and play strength length
51
S --> CHARTS
acute and post acute
52
acute S --> CHARTS
defer instability tests
53
post acute S --> CHARTS
anterior posterior inferior/MDI labrum
54
anterior special tests
apprehension jobe relocation test anterior load/shift
55
posterior special test
posterior load/shift kim test
56
inferior/MDI special test
sulcus sign
57
labrum special test
crank test apprehension test
58
differential dx
neurological testing
59
neurological testing --> differential dx
look for axillary nerve involvement deltoid/weakness atrophy teres minor weakness/atrophy sensory loss over lateral portion of shoulder
60
if nerve damage is apparent --> differential dx
EMG 3 wks post injury
61
other dx might see --> differential dx
soft tissue injury muscle tears vascular damage cervical pathology
62
common dx accompanying instability
bankart lesion hill-sachs lesion
63
bankart lesion
avulsion or tear of anterior capsule and inferior labrum inferior GH ligament pulls the inferior labrum away from the glenoid
64
bony bankart lesion
chip fx of anterior inferior glenoid rim
65
bankart lesion incidence
~87% w/ anterior dislocations
66
bankart lesion is a
common cause of instability
67
bankart repair
arthroscopic is the gold standard open bankart is traditional
68
what is the goal of bankart repair
restores tension to anteroinferior capsule and AIGHL
69
where are the sutures --> bankart
through glenoid and capsulolabral tissue to anatomically repaid labrum back to glenoid rim
70
hill-sachs lesion
impaction fx of posterior/superior aspect of humerus d/t compression of humerus against the anterior/inferior glenoid rim
71
hill-sachs could be
traumatic or atraumatic
72
when is hill-sachs frequently found
recurrent anterior instability
73
what can hill-sachs cause
painful catching clicking or popping
74
dx testing
x-ray CT scan MRI
75
x-ray --> dx testing
can visualize bankart or hill-sachs lesion need special views
76
what view can a bankart lesion NOT be seen on
AP
77
view for a bankart lesion
must use a modified axillary view (west point view)
78
west point view
pt prone w/ arm in 90 ABD and neutral rotation beam directed 25 degrees posterior to horizontal plane and 25 degrees medial to vertical plane
79
what view must be used for hills-sach lesion
stryker notch view
80
stryker notch view
pt is supine wi/ hand on top of head beam is A/P, centered at coracoid and angled 10 degrees towards the head evaluates posterior/superior humeral head

Ortho Exam 2 (17 decks)

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