Shoulder Instability

Question 1

What is the shoulder joint much less stable than?

Answer 1

Hip ball and socket joint

Question 2

What are types of static stabilizations in the shoulder?

Answer 2

Ligaments

Capsule

Bony anatomy

Question 3

What is a dynamic stabilizer in the shoulder?

Answer 3

Muscles

Question 4

What are the different types of instabilities in the shoulder?

Answer 4

Traumatic

Atraumatic

Acquired

Question 5

Who is shoulder instability more common in?

Answer 5

3x more common in men than women

Question 6

What is traumatic instability?

Answer 6

Subluxation

Dislocation

Question 7

What can a shoulder dislocation lead to?

Answer 7

Hill-Sachs lesion

Boney bankart

Labral tear

Axillary nerve injury

Question 8

What is a bankart lesion?

Answer 8

Tear of glenoid labrum in the anterior region

Question 9

What is a reverse bankart lesion?

Answer 9

Tear of glenoid labrum in the posterior region

Question 10

What is a Hills-Sach lesion?

Answer 10

Injury to humeral head due to anterior dislocation

Question 11

What is the most common type of disability?

Answer 11

Anterior disability (ER, abduction, anterior directed force)

Question 12

What are the causes of atraumatic instability?

Answer 12

Anatomical anomaly

General laxity

Poor muscle balance

Scapular dyskinesis

Connective tissue diseases (Ehlers-Danlos and Marfan syndrome)

Question 13

What are the causes of acquired instability?

Answer 13

Gradual development of laxity (pitchers)

Excessive ER

Posterior GH joint capsular tightness

Strength imbalance

Question 14

What is the clinical presentation of someone with traumatic instability?

Answer 14

Shoulder pain but localized to tissues involved (scared to move arm out from body)

Question 15

What is the clinical presentation of someone with atraumatic instability?

Answer 15

Multi joint hyper mobility

Atrophy of shoulder girdle

Dysfunctional movement patterns

Question 16

Who is at greater risk for recurrence of shoulder dislocations?

Answer 16

Younger patients in their 20s and men

Question 17

What results in a reduced risk of shoulder dislocation?

Answer 17

Boney bankart and greater tubercle fracture (due to surgical intervention)

Question 18

What are the 4 phases of a rehab program for anterior instability?

Answer 18

Phase 1- acute

Phase 2- intermediate

Phase 3- advanced strengthening

Phase 4- return to activity

Question 19

What are some exercises that are good to be used in the acute phase (phase 1)?

Answer 19

Rhythmic stabilization for IR/ER/shoulder flexion

Closed chain (arms held out against wall)

Scapular re training

Question 20

What are some exercises that can be used for the intermediate phase (phase 2)?

Answer 20

Rotator cuff strengthening (moving in early to mid range in multiple planes)

Closed chain (plank position)

Balancing with hand on a ball on the wall

Question 21

What are some exercises for the advanced strengthening phase (phase 3)?

Answer 21

Rotator cuff strengthening at end range

Neuromuscular training

Closed chain (wall push up on ball)

Question 22

What are some exercises for the return to activity phase (phase 4)?

Answer 22

Exercises that reflect what they want to return to

Question 23

What is TUBS?

Answer 23

Traumatic

Unidirectional (anterior, posterior, or inferior)

Associated bankart lesion

Surgical repair

Question 24

What is the prognosis of TUBS?

Answer 24

Good

Question 25

What is AMBRI?

Answer 25

Atraumatic Multidirectional Bilateral Rehab Inferior capsular shift (if surgery is done)

Question 26

What is the prognosis of AMBRI?

Answer 26

Less certain

Question 27

What position does an anterior GH dislocation usually occur in?

Answer 27

Anterior force on shoulder with arm abducted and ER (posterior force on forearm or hand)

Question 28

What position does a posterior GH dislocation occur in?

Answer 28

Posterior force on shoulder with arm flexed and IR

Question 29

What is the position where inferior GH dislocation often occurs?

Answer 29

Inferior force on shoulder with arm in abduction