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Glenohumeral joint instability - Coggle Diagram
Glenohumeral joint instability
definition
soft tissue/bony insult to shoulder, causing hunmeral head to sublux/dislocate from glenoid fossa
epidemiology
mostly anterior direction. (head of humerus comes out front), from trauma, and 70% from younger men and a peak in older women too
aetiology
younger men = contact sports, high velocity ot overhead force
older women = due to falls
signs and symptoms
clicking
pain
dead arm
posterior pain
positive apprehension tests etc
classification
TUBS
Traumatic, Unidirectional instability, Bankart lesion is pathology, Surgery required
AMBRI
Atraumatic, Multidirectional instability, Bilateral symptoms (both shoulders), Rehab for treatment
Stanmore triangle
Type 1 = traumatic and structural
Type 2 = atraumatic but structural eg hypermobile soft tissue
Beighton score, 9 points, quantifies joint laxity and hyper mobility
Type 3 = atraumatic but odd muscle pattering eg pops out shoulder when young etc
pathophysiology
atraumatic = chronic recurrent (from repetitive rotation with humerus abducted and extended), congenital insatbility eg bony anomalies, increased collagen elasticity...
bone, ligament, capsule, tendon issues
high recurrence after first time, especialy under 40 age
young people have more type 3 collagen which is more elastic, so the shoulder pops out and ligaments stretch and become baggy
Bankart lesion
shoulder pops out and pulls away some of labrum, causing reccurent instability
Bony Bankart lesion
knocks piece of bone away instead of labrum, can see it on imaging
Hills Sachs lesion
bony chunk out of humeral head as force of muscle pull humeral head back into glenoid and pull the bone
complications
neuro injury (axillary nerve), rotator cuff tear, greater tuberosity fracture
assessment
observation - prominent acromion and moving humeral head
ROM
muscle length testing of upper traps, lev scan, scalenes, lat doors, pec minor/major
strength of surrounding neck muscles and myotome testing of shoulder movements
stability tests = apprehension, relocation
neuro testing - sensory especially on axillary nerve area
motor control function - posture, scapular position, Beighton score, bony point tenderness and muscle tone
scapular movements eg shrugging, depression etc
treatment
reduction and immobilisation
ROM and reduce fear
strengthening deltoid and rotator cuffs
posture re education
strengthening posterior shoulder muscles
rotator cuff motor control
closed kinetic chain = eg arm fixed to floor/wall, then progress to open kinetic chain = arm is free
stretching shoulder areas
proprioception and coordination training for shoulder eg perturbations