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Shoulder instabilty

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This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available. …

This is a short presentation on shoulder instability, biomechanics, pathology, diagnostic modalities, clinical picture and treatment methods available.

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  • 1. Unstable Shoulder Dislocations around Shoulder Dr.A.Mohan krishna M.S.Ortho., MCh Orth (U.K) Consultant Orthopaedic surgeon Apollo Hospitals, Hyderabad. Consultant Orthopedic surgeon
  • 2. NORMAL SHOULDER JOINT
  • 3. BIOMECHANICS Glenoid labrum • Increases depth of cup by 20% Ligaments • Glenohumeral Ligaments • Joint capsule Muscles • Rotatorcuff muscles • Biceps Dynamic • Proprioceptive feedback
  • 4. static Dynamic Concavity compression Deltoid & biceps Rotator cuff muscles Joint fluid adhesiveness Ligament & capsule Glenoid Labrum Negative intraarticular pressure
  • 5. BIOMECHANICS The glenohumeral joint will not dislocate as long as the net humeral joint reaction force is directed within the effective glenoid arc
  • 6. ANTERIOR DISCLOCATION POSTERIOR DISLOCATION MULTIDIRECTIONAL DIRECTION OF DISLOCATION
  • 7. Congenital Acute traumatic Atraumatic Types of Instability
  • 8. TUBS Traumatic Unidirectional Bankart Surgery AMBRI Atraumatic Multidirectional Bilateral Rehab Inferior Capsular shift Recurrent Instability
  • 9. Anterior - 97% of dislocations. - Subcoracoid - Subglenoid - Subclavicular - Intrathoracic Posterior - 3% - Seizures, - Subacromial, - Subglenoid, - Subspinous Direction of Instability
  • 10. ASSOCIATED INJURIES Bankarts Lesion Hill Sachs Lesion
  • 11. EVALUATION OF RECURRENTTRAUMATIC INSTABILITY History trauma sports Throwing or overhead activities
  • 12. EVALUATION OF RECURRENT ATRAUMATIC INSTABILITY Historytrauma Generalised ligament laxity Throwing or overhead activities Voluntary subluxation History of fear of dislocating
  • 13. Clinical Evaluation Anterior dislocation Abducted and externally rotated Limited internal rotation Loss of rounded contour of shoulder Posterior Dislocation Sling position of Adduction & Internal Rotation Limited External Rotation & Elevation of arm Posterior prominence of shoulder
  • 14. Clinical Evaluation Laxity tests Drawers test Sulcus test Push -Pull Stability tests Fulcrum Apprehension test JerkTest
  • 15. INVESTIGATIONS X-Rays Bony bankarts lesion Hill Sach’s lesion MRI Status of soft tissues MR arthrogram Bankarts lesion, SlAP lesions
  • 16. ANTERIOR DISLOCATION APVIEW SCAPULAR ‘Y’VIEW CLINICAL
  • 17. POSTERIOR DISLOCATION AP View Axillary View Clinical
  • 18. GENERALISED LIGAMENT LAXITY
  • 19. HABITUAL DISLOCATION
  • 20. CONGENITAL DISLOCATION
  • 21. MANAGEMENT Closed manipulation and reduction IV Sedation Anesthesia Open reduction Immobilization for 4 to 6 weeks
  • 22. SHOULDER STRENGTHENING
  • 23. MANAGEMENT OF RECURRENT ANTERIOR DISLOCATION RECURRENT TRAUMATIC ANTERIOR DISLOCATION Surgical stabilization Open Arthroscopic Poor response to Non Operative treatment ATRAUMATIC INSTABILITY 80% responds to physio Surgical stabilization Capsulorraphy if non operative feels
  • 24. MULTIDIRECTIONAL INSTABILITY MULTIDIRECTIONAL INSTABILITY Surgery only if non-operative fails Surgery – Capsulorraphy
  • 25. BANKARTS REPAIR
  • 26. BANKARTS REPAIR
  • 27. BRISTOW’S PROCEDURE Coracoid tip along with the conjoined tendon is transferred to the anteroinferior glenoid neck which acts acts like bone block in front of the humeral head.
  • 28. THANK YOU

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