shoulder instability shoulder instability presented by: dr.abdulrahman algarni dr.abdulrahman...
DESCRIPTION
Anatomy and biomechanics Static and Dynamic Restriants. Static include glenoid labrum,articular conformity,negative pressure,capsule and capsuloligamentous structures. The Ant capsule is tight during Ext Rot & the Post during Int Rot.TRANSCRIPT
Shoulder InstabilityShoulder Instability
Presented byPresented by : :
Dr.Abdulrahman AlgarniDr.Abdulrahman Algarni
��Shoulder is the most commonly Shoulder is the most commonly dislocated joint .In 95% the dislocated joint .In 95% the displacement is anterior and the displacement is anterior and the remainder is posterior or remainder is posterior or multidirectional.multidirectional.
Anatomy and biomechanicsAnatomy and biomechanicsStatic and Dynamic Restriants . Static and Dynamic Restriants .
Static include glenoid Static include glenoid labrum,articular conformity,negative labrum,articular conformity,negative pressure,capsule and pressure,capsule and capsuloligamentous structures. The capsuloligamentous structures. The Ant capsule is tight during Ext Rot & Ant capsule is tight during Ext Rot & the Post during Int Rot. the Post during Int Rot.
These include CHL and SGHL:limit Inf These include CHL and SGHL:limit Inf Trans & Ex Rot(Add),Post Trans & Ex Rot(Add),Post Trans(Flex,Add,Int Rot) . MGHL limit Trans(Flex,Add,Int Rot) . MGHL limit Inf Trans(Add,Ex Rot) ,Ex Rot (Add), Inf Trans(Add,Ex Rot) ,Ex Rot (Add), Ant-Post Trans (45 Abd,Ex Rot).Ant-Post Trans (45 Abd,Ex Rot).
The IGHLC is the primary restraint to The IGHLC is the primary restraint to Ant,Pos,and Inf Trans (45-90 Abd). Ant,Pos,and Inf Trans (45-90 Abd). The Dynamic restraints include joint The Dynamic restraints include joint concavity compression produced by concavity compression produced by synchronised contraction of Rotator synchronised contraction of Rotator Cuff.Cuff.
Anterior InstabilityAnterior Instability
Posterior InstabilityPosterior InstabilityMany cases are atraumatic . Acute Many cases are atraumatic . Acute
post dislocation is rare ,history of post dislocation is rare ,history of epilpsy or severe electric shock +/- epilpsy or severe electric shock +/- fracture of the proximal humerus or fracture of the proximal humerus or indentation.indentation.
DiagnosisDiagnosisIn the acute stage : held in Int Rot & In the acute stage : held in Int Rot &
resist Ex Rot. AP X-Ray : light-bulb resist Ex Rot. AP X-Ray : light-bulb appearance of proximal humerus and appearance of proximal humerus and Axillary veiw if abduction is possible.Axillary veiw if abduction is possible.
Recurrent instability is almost always a Recurrent instability is almost always a posterior subluxation when the arm posterior subluxation when the arm is held in Flex & Int Rot. is held in Flex & Int Rot. + posterior drawer test + posterior drawer test + posterior apprehension + posterior apprehension test test
TreatmentTreatmentMany cases are best treated by Many cases are best treated by
physiotherapy. Surgery is indicated physiotherapy. Surgery is indicated with recurrent traumatic or with recurrent traumatic or persistent atrumatic instability with persistent atrumatic instability with no gross joint laxity. Recurrence is no gross joint laxity. Recurrence is upto 50%.upto 50%.
These include : These include : -Posterior capsulorraphy. -Posterior capsulorraphy. -Posterior bone block. -Posterior bone block. -Posterior glenoid osteotomy -Posterior glenoid osteotomy with excessive glenoid retroversion. with excessive glenoid retroversion.
Multidirectional InsabilityMultidirectional InsabilityUsually atraumatic ,bilateral , Usually atraumatic ,bilateral ,
associated with ligamentous laxity associated with ligamentous laxity and sometimes weakness of shoulder and sometimes weakness of shoulder muscles.muscles.
Clinical FeaturesClinical Features- Difficult to diagnose with certainty , - Difficult to diagnose with certainty ,
but is suggested when both anterior but is suggested when both anterior & posterior drawer , apprehension & posterior drawer , apprehension test and sulcus sign are positive test and sulcus sign are positive often with joint laxity elsewhere .often with joint laxity elsewhere .
TreatmentTreatment- Physiotherapy - Physiotherapy
-Surgical treatment : -Surgical treatment : -Arthroscopic thermal capsular -Arthroscopic thermal capsular shrinkage -Inferior capsular shift .shrinkage -Inferior capsular shift .