Shoulder Instability-Dislocation

Question 1

What is shoulder instability due to?

Answer 1

1. Laxity of the capsule/ligaments
   *once a shoulder dislocates or subluxes, it is more likely to do it repetitively

Question 2

What is the most common type of shoulder dislocation?

Answer 2

Anterior

Question 3

What are the symptoms?

Answer 3

1. Shoulder feels like it wants to “come out” worse with abduction and ER
   *will be a history of trauma with inital dislocation

Question 4

If a patient can do a voluntary dislocation what does that mean?

Answer 4

1. There is a worse prognosis
   *indicates multidirectional instability

Question 5

What will be on the PE?

Answer 5

1. Painful ROM (if acute dislocation)
   Anterior: arm at neutral (shoulder is to the front)
   *apprehension test
   Posterior: arm in adduction and internal rotation (unable to externally rotate)
   *jerk test
   Inferior: arm at neutral
   *sulcus sign (dimple)

Question 6

What are the diagnostic tests?

Answer 6

1. Radiographs
   *Hill-Sachs lesions (indicative of anterior dislocation)
   *Bankart lesion
2. MRI
   *assessment of RTC and capsule/ligaments

Question 7

What is the treatment?

Answer 7

1. Reduce dislocations
   *PT if first occurrence
   *Surgery if labral repair or capsulorrhapy is indicated

Question 8

What is a Hills-Sachs lesion?

Answer 8

1. Posterolateral humeral head compression fracture (dent in the humeral head at the back)
   *secondary to recurrent anterior shoulder dislocations

Question 9

What is a Bankart lesion?

Answer 9

1. Injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation
   *a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it

Question 10

What are the ways to reduce a shoulder dislocation?

Answer 10

1. ER, traction, and adduction at elbow
2. Traction and counter-traction with sheet