Shoulder Instability

Question 1

bankart lesion

Answer 1

Tear of the glenoid labrum in the anterior region of the glenoid

Question 2

Reverse Bankhart lesion

Answer 2

Tear of the glenoid labrum in the posterior region of the glenoid

Question 3

Hill sachs lesion

Answer 3

Compression fracture of the humeral head occurring as a result of traumatic dislocation anteriorly

Occurs at the posterior lateral humeral head in response to anterior dislocation

ER , abduction and anterior force on humerus, humeral head(postlat) is forced onto glenoid rim

Question 4

reverse hill sachs

Answer 4

Humerus is internally rotated, flexed, and adduction
and posterior translation of the humerus onto the glenoid rim

occurs anteromedial and from posterior dislocation

Question 5

Anterior instability

Answer 5

90-95%
unidirectional with traumatic onset
combined position of abduction and external rotation
May have anteroinferior labrum disruption

Question 6

posterior instability

Answer 6

2 to 10%

uniDirectional with repetitive loading (bench press)
Combine position of adduction and internal rotation
May have posterior labrum disruption

Question 7

Multi directional instability

Answer 7

1-3%
not typically associated with traumatic episodes
Congenital or acquired laxity

Connective tissue disorder, possibly

Question 8

MOI for anterior dislocations

Answer 8

Fall with a combination of abduction extension, and a posteriorly directed force on the arm

Fall on an outstretched hand is a common mechanism in the elderly

Question 9

Atraumatic injury, MOI

Answer 9

Anatomical anomaly
General laxity
Poor muscle balance
Scapular dyskinesis
CT diseases like ehlers danlos syndrome or Marfan syndrome

Question 10

acquired instability

Answer 10

Gradual development of laxity
Excessive ER
Posterior Glenohumeral joint capsular tightness
strength imbalance

Question 11

clinical presentation of traumatic injury

Answer 11

Depends on etiology, direction of instability, severity, and frequency

pain generalized the shoulder, but localized to the tissues involved
Apprehensive to moving arm out from body

Question 12

clinical presentation of atraumatic injury

Answer 12

General multi joint hypermobility

Loose inferior capsule

Atrophy shoulder girdle

Dysfunctional movement patterns

Question 13

Observation for instability

Answer 13

protective posture
Presence of observable deformity, or muscle atrophy

Question 14

Strength for instability examination

Answer 14

Limited by pain, weak abduction and external rotation, especially in the end ranges

Ability to coactivate dynamic stabilizers lightly diminished

check RC and scapular muscles

Question 15

anterior instability clinical item cluster

Answer 15

apprehension test
Relocation test
Surprise test

Anterior drawer test

Question 16

Posterior instability test

Answer 16

Jerk test

Question 17

Labral tear test

Answer 17

Kim test

Biceps load test two

Question 18

Risks for recurring dislocations

Answer 18

age related
Patients in their 20s have 60% rate at recurrence
Patients in their 30s have a 20% rate of recurrence

Gender more men than woman

Reduced risk of recurrence with fractures, including body Bankhart and greater tubercle fracture

Question 19

Considerations for rehab

Answer 19

onset of instability
Degree of instability
Frequency of episodes
Direction of instability
Concomitant abnormalities or injuries
end range neuromuscular control
Pre-morbid activity level

Question 20

Anterior instability, rehab phases

Answer 20

1- acute phase
2- intermediate phase
3- advanced strengthening
4- return to activity

Question 21

acute phase goals

Answer 21

Diminished pain inflammation, and muscle guarding

Promote and protect healing, soft tissues

Prevent negative effects of immobilization

Reestablish, baseline, dynamic joint stability

Prevent further damage to the GH joint capsule

Question 22

acute phase interventions

Answer 22

Immobilization
PROM- early motion in a protective range
Strengthening- sub maximal pain-free isometrics
dynamic stabilization
-IR/ER performed in scapular plane
-flexion performed at 100° flexion 10° horizontal adduction
-closed Kinetic chain

Question 23

Criteria to enter the intermediate phase

Answer 23

reduced pain and improved motor control

Question 24

intermediate phase goal

Answer 24

To reestablish muscle balance and restore full active range of motion

Question 25

intermediate phase interventions

Answer 25

Passive range of motion and active assisted range of motion performed to the patient tolerance internal and external rotation at 90° of abduction Strength stabilization at mid range

Question 26

Criteria to enter the advanced strengthening phase

Answer 26

minimal pain Full range of motion Symmetric capsular mobility Good strength 4.5 MMT Strength, endurance, and dynamic stability of the scapulothoracic and upper extremity regions

Question 27

Advanced strengthening phase goals

Answer 27

emphasis on strength and dynamic stabilization at end ranges Return to full daily activities

Question 28

Advanced strengthening phase interventions

Answer 28

Low and high repetitions Incorporation of co contraction and dynamic stabilization Begin low intensity plyometrics for the athlete returning to sport

Question 29

return to activity phase goals

Answer 29

Emphasis of the space that you perform strength program, dynamic stability and neural muscular control maintain full functional and pain-free range of motion Sports specific activities with plyometrics PNF and isotonic strengthening as it relates to the individual