Shoulder instability

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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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  • complexity of topic made simple but little more stuff is needed.
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Shoulder instability

  1. 2. 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
  2. 3. 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.
  3. 4. IN CONTEXT OF INSTABLITY WE MUST KNOW WHAT ARE THE STABILIER OF GLENOHUMERAL JOINT--???
  4. 6. TYPE OF INSTABILTY
  5. 7. <ul><li>BANKART LESION- INJURY TO ANT./INFERIOR GLENIOD LABRUM. </li></ul><ul><li>DUE TO REPEATED ANT. SH. DISLOACTION . </li></ul><ul><li>WITH DAMAGE OF INFERIOR G.H LIG. </li></ul><ul><li>TREATMENT- SURGICAL REPAIR </li></ul>
  6. 8. HILL SAC LESION- DAMAGE TO POSTERIOR HUMERAL HEAD WHICH RESULT FROM ANT. SH. DISLOCATION., . THERE MAY B COMPRESSION FRACTURE . OF POSTERO-LATERAL HUM HEAD.
  7. 10. <ul><li>DIAGNOSIS- </li></ul><ul><li>A-P VIEW </li></ul><ul><li>2.LATERAL VIEW </li></ul><ul><li>3. AXILLARY VIEW => A.P VIEW+ INTERNAL ROTATION </li></ul><ul><li>4. STRYKER NOTCH VIEW => A.P VIEW + EXTERNAL ROTATION </li></ul><ul><li>5. WEST POINT VIEW=> K/AS MODIFIED AXILLARY VIEW TO ROLE OUT BANKART LESION WITH ANT. INSTABILITY. </li></ul>
  8. 11. 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. .
  9. 12. 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.
  10. 13. 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.
  11. 14. <ul><li>TREATMENT- </li></ul><ul><li>1.REDUCTION </li></ul><ul><li>2.ARTHROSCOPIC SURGERY </li></ul><ul><li>3.OPEN REPAIR </li></ul><ul><li>4.REHABILITAITON </li></ul><ul><li>REDUCTION – AS SOON AS POSSIBLE. IN CASES WITH ACUTE DISLOCATION. </li></ul><ul><li>2 COMMON TECHNIQUES USED IN REDUCTION. </li></ul><ul><li>KOCHER METHOD & STIMSON METHOD. </li></ul><ul><li>KOCHER METHOD- PATIENT IN SUPINE BODY STABILIZED, </li></ul><ul><li>APPLY TRACTION ON HUMERUS WHILE ARM IS ADDCUCTED, EXTERNALLY ROTATED </li></ul><ul><li>THEN FLEXED POSITON … </li></ul><ul><li>IF REDUCTION NOT OCCUR THEN </li></ul><ul><li>MOVE THE ARM IN INTERNAL ROTATION THEN FURTHER ADDUCT. </li></ul>
  12. 15. 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 .
  13. 16. <ul><li>2 . EARLY ARTHOSCOPIC SURGERY- </li></ul><ul><li>IN PATIENT UNDER AGE 25 TO PREVENT FURTHER EPISODES OF ANTERIOR DISLOACTION . </li></ul><ul><li>3. OPEN REPAIR- </li></ul><ul><li>IN PATIENT WITH RECUREENT INSTABILITY. / CAPSULAR LAXITY. </li></ul><ul><li>MORE EXPENSIVE & INTENSIVE. </li></ul><ul><li>** USUALLY IN POSTERIOR & MULTIDIRECTION INSTABILITY RESPOND TO </li></ul><ul><li>.CONSERVATIVE TREATMENT WITH PHYSICAL REHABILITATION . </li></ul>

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