oku review chapter 24 – shoulder instability. 24 year male presents with a traumatic shoulder...
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OKU REVIEWOKU REVIEWCHAPTER 24 – SHOULDER CHAPTER 24 – SHOULDER
INSTABILITYINSTABILITY
24 year male presents with a 24 year male presents with a traumatic shoulder dislocation traumatic shoulder dislocation that was reduced. He is now 3 that was reduced. He is now 3 days out and in a sling. Which days out and in a sling. Which
of the following is true?of the following is true?A. There is a high likelihood of having a rotator cuff A. There is a high likelihood of having a rotator cuff tear.tear.
B. He will most likely have the same if not better B. He will most likely have the same if not better quality of life and sporting activities once quality of life and sporting activities once rehabilitation starts.rehabilitation starts.
C. He will likely dislocate his shoulder again.C. He will likely dislocate his shoulder again.
D. All of the above are trueD. All of the above are true
24 year male presents with a 24 year male presents with a traumatic shoulder dislocation traumatic shoulder dislocation that was reduced. He is now 3 that was reduced. He is now 3 days out and in a sling. Which days out and in a sling. Which
of the following is true?of the following is true?A. There is a high likelihood of having a rotator cuff A. There is a high likelihood of having a rotator cuff tear.tear.
B. He will most likely have the same if not better B. He will most likely have the same if not better quality of life and sporting activities once quality of life and sporting activities once rehabilitation starts.rehabilitation starts.
C. He will likely dislocate his shoulder again.C. He will likely dislocate his shoulder again.
D. All of the above are trueD. All of the above are true
Describe the difference Describe the difference between laxity and between laxity and
instability.instability.
Describe the difference Describe the difference between laxity and between laxity and
instability.instability.Laxity = objective measurement of joint mobilityLaxity = objective measurement of joint mobility
Instability = subjective symptomatology associated Instability = subjective symptomatology associated with excessive joint motion.with excessive joint motion.
Which of the following are Which of the following are important regarding important regarding
patient history?patient history?A. Direction of instability.A. Direction of instability.
B. Number of episodes of instability.B. Number of episodes of instability.
C. Both A and B.C. Both A and B.
Which of the following are Which of the following are important regarding important regarding
patient history?patient history?A. Direction of instability.A. Direction of instability.
B. Number of episodes of instability.B. Number of episodes of instability.
C. Both A and B.C. Both A and B.
The anterior apprehension The anterior apprehension test is used to test is used to
test/evaluate what type of test/evaluate what type of instabilty?instabilty?
The anterior apprehension The anterior apprehension test is used to test is used to
test/evaluate what type of test/evaluate what type of instabilty?instabilty?
Anterior instabilityAnterior instability
What test is used in What test is used in conjunction with conjunction with
apprehension test?apprehension test?
What test is used in What test is used in conjunction with conjunction with
apprehension test?apprehension test?Relocation test.Relocation test.
What special test is used to What special test is used to evaluate posterior evaluate posterior
instability?instability?
What special test is used to What special test is used to evaluate posterior evaluate posterior
instability?instability?Jerk test.Jerk test.
The sulcus sign evaluates The sulcus sign evaluates what type of instability?what type of instability?
The sulcus sign evaluates The sulcus sign evaluates what type of instability?what type of instability?
Inferior instability.Inferior instability.
What anatomic structure is What anatomic structure is often incompetent when the often incompetent when the sulcus sign is present with sulcus sign is present with
shoulder ext. rotation?shoulder ext. rotation?
What anatomic structure is What anatomic structure is often incompetent when the often incompetent when the sulcus sign is present with sulcus sign is present with
shoulder ext. rotation?shoulder ext. rotation?Rotator interval.Rotator interval.
What x-ray view is What x-ray view is paramount for evaluation paramount for evaluation of shoulder dislocations?of shoulder dislocations?
What x-ray view is What x-ray view is paramount for evaluation paramount for evaluation of shoulder dislocations?of shoulder dislocations?Axillary lateral.Axillary lateral.
Match the x-ray view with Match the x-ray view with the appropriate pair.the appropriate pair.
A. West PointA. West Point
B. Stryker NotchB. Stryker Notch
C. ZancaC. Zanca
1. Hill-Sachs lesion1. Hill-Sachs lesion
2. Bony Bankart2. Bony Bankart
3. AC Joint3. AC Joint
Match the x-ray view with Match the x-ray view with the appropriate pair.the appropriate pair.
A. West Point – 2. Bony BankartA. West Point – 2. Bony Bankart
B. Stryker Notch – 1. Hill-Sachs lesionB. Stryker Notch – 1. Hill-Sachs lesion
C. Zanca – 3. AC JointC. Zanca – 3. AC Joint
What position of the What position of the shoulder reapproximates shoulder reapproximates
the anterior labrum the anterior labrum anatomically?anatomically?Internal rotation (as if in a sling)Internal rotation (as if in a sling)
Slight flexionSlight flexion
External rotationExternal rotation
Neutral rotation and extensionNeutral rotation and extension
What position of the What position of the shoulder reapproximates shoulder reapproximates
the anterior labrum the anterior labrum anatomically?anatomically?Internal rotation (as if in a sling)Internal rotation (as if in a sling)
Slight flexionSlight flexion
External rotationExternal rotation
Neutral rotation and extensionNeutral rotation and extension
What complications results from What complications results from nonanatomic reconstructions of nonanatomic reconstructions of the anterior shoulder (Putti-Platt the anterior shoulder (Putti-Platt
and Magnuson-Stack)?and Magnuson-Stack)?
What complications results from What complications results from nonanatomic reconstructions of nonanatomic reconstructions of the anterior shoulder (Putti-Platt the anterior shoulder (Putti-Platt
and Magnuson-Stack)?and Magnuson-Stack)?1. Significant loss of motion1. Significant loss of motion
2. OA2. OA
According to a recent study According to a recent study involving the Bristow-Latarjet involving the Bristow-Latarjet
procedure, what radiograph was procedure, what radiograph was the most accurate view for the most accurate view for
revealing OA?revealing OA?
According to a recent study According to a recent study involving the Bristow-Latarjet involving the Bristow-Latarjet
procedure, what radiograph was procedure, what radiograph was the most accurate view for the most accurate view for
revealing OA?revealing OA?Subcoracoid projection (angeld inferiorly 45 Subcoracoid projection (angeld inferiorly 45 degrees from above)degrees from above)
The true AP view tended to minimize/miss arthritic The true AP view tended to minimize/miss arthritic changes.changes.
What is the first line What is the first line treatment of treatment of
multidirectional instability?multidirectional instability?
What is the first line What is the first line treatment of treatment of
multidirectional instability?multidirectional instability?Aggressive Physical TherapyAggressive Physical Therapy
Maximize strength and balance of the dynamic Maximize strength and balance of the dynamic stabilizers (cuff, delt, scap)stabilizers (cuff, delt, scap)
Patient EducationPatient Education
Activity ModificationActivity Modification
Match the structure with Match the structure with the appropriate restraint.the appropriate restraint.
A. Posterior Band IGHLA. Posterior Band IGHL
B. Rotator Interval (Coracohumeral and superior B. Rotator Interval (Coracohumeral and superior GHL)GHL)
1. Posterior restraint with the arm flexed, add, IR.1. Posterior restraint with the arm flexed, add, IR.
2. Posterior restraint with the arm in abd2. Posterior restraint with the arm in abd
Match the structure with Match the structure with the appropriate restraint.the appropriate restraint.
A. Posterior Band IGHL – resists posterior A. Posterior Band IGHL – resists posterior translation with the arm in abd (A-2).translation with the arm in abd (A-2).
B. Rotator Interval (Coracohumeral and superior B. Rotator Interval (Coracohumeral and superior GHL) – Posterior restraint with the arm flexed, ADD, GHL) – Posterior restraint with the arm flexed, ADD, IR (B-1).IR (B-1).
What procedure is What procedure is performed after primary performed after primary anteroinferior instability anteroinferior instability
treatment fails?treatment fails?
What procedure is What procedure is performed after primary performed after primary anteroinferior instability anteroinferior instability
treatment fails?treatment fails?Bristow-Latarjet repairBristow-Latarjet repairCoracoid to the anterior glenoid rim transfer.Coracoid to the anterior glenoid rim transfer.
Provides bony reinforcement as well as a soft-tissue sling Provides bony reinforcement as well as a soft-tissue sling of conjoined tendons when the arm is abd and ER.of conjoined tendons when the arm is abd and ER.
Describe the 6 types of AC Describe the 6 types of AC Joint SeparationJoint Separation
Describe the 6 types of AC Describe the 6 types of AC Joint SeparationJoint Separation
Type IType I
Nondisplaced sprainNondisplaced sprain
Type IIType II
Tear AC lig with intact CC ligTear AC lig with intact CC lig
Mild clavicular displacementMild clavicular displacement
Type IIIType III
Comple tear AC and CC ligComple tear AC and CC lig
100% superior displacement of the clavicle100% superior displacement of the clavicle
Type IVType IV
Posterior displacement Posterior displacement
Type VType V
100-300% superior displacement100-300% superior displacement
Type VIType VI
Inferior displacement locked beneath the coracoidInferior displacement locked beneath the coracoid
What type is basically What type is basically always treated nonsx?always treated nonsx?
What type is basically What type is basically always treated nonsx?always treated nonsx?
Type IType I
Which types basically Which types basically always get treated with sx?always get treated with sx?
Which types basically Which types basically always get treated with sx?always get treated with sx?
Types IV, V, VITypes IV, V, VI
What x-ray view is used to What x-ray view is used to help evaluate SC help evaluate SC
instability?instability?
What x-ray view is used to What x-ray view is used to help evaluate SC help evaluate SC
instability?instability?Serendipity viewSerendipity view
40 degree cephalic tilt40 degree cephalic tilt
BUT… CT is accepted as the study of choice.BUT… CT is accepted as the study of choice.
What direction may lead to What direction may lead to major vascular/chest major vascular/chest
injury?injury?
What direction may lead to What direction may lead to major vascular/chest major vascular/chest
injury?injury?Posterior SC dislocationsPosterior SC dislocations
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