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Shoulder instability
 

Shoulder instability

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Brief review of Shoulder instability in young athletes. ...

Brief review of Shoulder instability in young athletes.

This ppt includes definition,causes,types of instability, bankart & hill sac's lesion, diagnosis, treatment (both reduction ), and rehabilitation protocol..

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    Shoulder instability Shoulder instability Presentation Transcript

    •  
    • INCLUDE A SPECTRUM OF DISORDER 1. DISLOCATION- COMPLETE LOSS OF GLENOHUMERAL ARTICULATION . CAUSE- ACUTE TRAUMA 2. SUBLUXATION - PARTIAL LOSS OF ARTICULATION WITH SYMPTOM’S. CAUSE- REPITITIVE TRAUMA. 3. LAXITY - PARTIAL LOSS OF GLENOHUMERAL ARTICULATION BUT PAITENT IS ASYMPTOMATIC. SHOULDER INSTABLITY
    • CAUSES- REPITITIVE OVERHEAD ACTIVITY LIKE BASE BALL,VOLLEYBALL,CRICKET ETC. OVERHEAD ACTIVITY REQUIRE ABDUCTION AND EXTERNAL ROTATION WHICH IS THE WEAKEST POINT OF G.H JOINT BIOMECHANICALLY.
    • IN CONTEXT OF INSTABLITY WE MUST KNOW WHAT ARE THE STABILIER OF GLENOHUMERAL JOINT--???
    •  
    • TYPE OF INSTABILTY
      • BANKART LESION- INJURY TO ANT./INFERIOR GLENIOD LABRUM.
      • DUE TO REPEATED ANT. SH. DISLOACTION .
      • WITH DAMAGE OF INFERIOR G.H LIG.
      • TREATMENT- SURGICAL REPAIR
    • HILL SAC LESION- DAMAGE TO POSTERIOR HUMERAL HEAD WHICH RESULT FROM ANT. SH. DISLOCATION., . THERE MAY B COMPRESSION FRACTURE . OF POSTERO-LATERAL HUM HEAD.
    •  
      • DIAGNOSIS-
      • A-P VIEW
      • 2.LATERAL VIEW
      • 3. AXILLARY VIEW => A.P VIEW+ INTERNAL ROTATION
      • 4. STRYKER NOTCH VIEW => A.P VIEW + EXTERNAL ROTATION
      • 5. WEST POINT VIEW=> K/AS MODIFIED AXILLARY VIEW TO ROLE OUT BANKART LESION WITH ANT. INSTABILITY.
    • SPECIAL TEST- 1.LOAD AND SHIFT TEST- PATIENT HUMERUS HEAD IS LOADED AND PUSHED AGAINST THE GLENOID FOSSA.. IF HEAD MOVE OUT ANT.LY- ANT. DISLOCATN MOVE OUT POST.LY- POST DISLOCATION. 2. APPREHENSION TEST-/ CRANK TEST -- SAME AS RELOCATION PAITENT FEELS THAT SH. IS GOING TO SLIP OUT. 3.DRAWER TEST- EXAMINER PUSH THE HUMERAL HEAD AGAINST THE GLENOID FOSSA THEN MOVES IT ANT.LY AND POST.LY TEST + WITH THE DISPLACEMENT. .
    • 2.RELOCATION TEST- PATIENT HUMERUS ABD. + EXTERNALLY ROT. USE THE TABLE EDGE AS FULCRUM. TEST +VE WHN P’T EXPERIENCE APPREHENSION WHICH IS RELIEVED BY POST. STRESS ON SH.
    • 5.SULCUS TEST- CAUDAL TRACTION IS APPLIED TO THE HUMERUS ATTEMPT TP DISPLACE THE HUMERUS INFERIORLY. TEST +VE WHEN MULTIDIRECTIONAL INSTABILITY. WITH MOON SHAPE APPEARANCE ON SUPERIOR ASPECT OF HUMERUS.
      • TREATMENT-
      • 1.REDUCTION
      • 2.ARTHROSCOPIC SURGERY
      • 3.OPEN REPAIR
      • 4.REHABILITAITON
      • REDUCTION – AS SOON AS POSSIBLE. IN CASES WITH ACUTE DISLOCATION.
      • 2 COMMON TECHNIQUES USED IN REDUCTION.
      • KOCHER METHOD & STIMSON METHOD.
      • KOCHER METHOD- PATIENT IN SUPINE BODY STABILIZED,
      • APPLY TRACTION ON HUMERUS WHILE ARM IS ADDCUCTED, EXTERNALLY ROTATED
      • THEN FLEXED POSITON …
      • IF REDUCTION NOT OCCUR THEN
      • MOVE THE ARM IN INTERNAL ROTATION THEN FURTHER ADDUCT.
    • STIMSON TECHNIQUE B) STIMSON METHOD- PATIENT IN PRONE AND A WEIGHT IS PLACED ON DISLOCATED ARM. THE HUMERUS SPONTANEOUSLY RETURN TO ITS NORMAL POSTION WITH THE AID OF GRAVITY .
      • 2 . EARLY ARTHOSCOPIC SURGERY-
      • IN PATIENT UNDER AGE 25 TO PREVENT FURTHER EPISODES OF ANTERIOR DISLOACTION .
      • 3. OPEN REPAIR-
      • IN PATIENT WITH RECUREENT INSTABILITY. / CAPSULAR LAXITY.
      • MORE EXPENSIVE & INTENSIVE.
      • ** USUALLY IN POSTERIOR & MULTIDIRECTION INSTABILITY RESPOND TO
      • .CONSERVATIVE TREATMENT WITH PHYSICAL REHABILITATION .
    •