Adolescent atraumatic shoulder instability

953 views
834 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
953
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Adolescent atraumatic shoulder instability

  1. 1. Adolescent  Atrauma/c  Shoulder   Instability   Anju  Jaggi   Clinical  Physiotherapy  Specialist   I   RNOHT/President  of  EUSSER  III   II  
  2. 2. Young  vs  Old  •  Inherently  mobile   –  Predisposed  to  instability  •  Func/ons  more  in  the   ‘Outer  cone’  •  Rotator  cuff   –  Imbalanced  vs   structurally  incompetent  •  Demands  more  on  the   Kine/c  chain  
  3. 3. Stanmore  Triangle   Trauma/c   Atrauma/c     II   Structural  Muscle  PaNerning   Capacity  for  complexity   Con/nuum  of  different  ae/ologies  
  4. 4. Age  vs  Ae/ology  
  5. 5. Biomechanical  Issue  •  Skeletal  immaturity   –  Glenoid  hypoplasia   –  Humeral  retroversion  •  Osseous  adapta/on   –  Cause  or  affect?  •  Shoulder  hyperlaxity   –  Sulcus/posterior  draw  •  Generalised  laxity   –  EDS/JHS  
  6. 6. Bio-­‐Psychosocial  •  Sport   –  Intensity   –  Frequency   –  Types  of  sports  •  No  physical  exercise   –  Lack  of  condi/oning/tone  •  Puberty/growth  •  Social  pressure   –  Body  image   –  Peers  
  7. 7. Physical  Perspec/ve   What  would  I  assess?  •  Beighton  score   –  Brighton  Criteria  •  Shoulder  laxity  •  Passive  vs  Ac/ve   rota/onal  arc  •  Compensatory   mechanisms   –  Scapula  involvement   –  Aberrant  muscle   recruitment   –  Kine/c  chain  
  8. 8. How  would  I  treat  it?  •  Make  the  environment   conducive   –  Educa/on   –  Pacing  –  find  a  happy   medium   –  Increase  levels  of  ac/vity   –  Ergonomics   –  Prolonged  postures/ sustained  repe//ve   ac/vi/es  
  9. 9. Type  II  Atrauma/c  •  Essen/ally  an   imbalanced  RC  •  Establish  Control  in  the   hypermobile  range  •  MDI  –  focus  on  en/re   RC  and  deltoid  •  Establish  a  balanced  RC    •  Incorporate  the  kine/c   chain  
  10. 10. Cuff  Control  Unsupported   Supported  
  11. 11. Type  III  -­‐  Atrauma/c  •  Work  more  globally     –  Core  control     –  Scapula  stability  •  More  propriocep/ve   work   –  Closed  chain   –  Biofeedback   –  FES    •  Work  towards  a   founda/on  on  which  to   work  a  RC  
  12. 12. Incorporate  core  with  Shoulder  
  13. 13. Conclusion  •  Atrauma/c  instability  is  mul/factorial  •  Skeletal  immaturity  •  Motor  control  immaturity?!  •  Demands  of  func/on  –  outer  cone/stamina  •  Puberty?  •  Too  much  movement  not  enough  stability  •  REHAB  remains  the  treatment  of  choice!  
  14. 14. JOIN  TODAY  –  Discounted  rates  for  courses  &  conferences  –  Access  to  the  Shoulder  &  Elbow  journal  –  Access  to  reviews  of  recent  scien/fic  papers  –  Network  of  professionals  Become  ac/ve  to  make  a  difference!   WWW.EUSSER.ORG  

×