OKU REVIEW CHAPTER 24 – SHOULDER INSTABILITY

1. OKU REVIEWCHAPTER 24 – SHOULDER INSTABILITY

2. 24 year male presents with a traumatic shoulder dislocation that was reduced. He is now 3 days out and in a sling. Which of the following is true? • A. There is a high likelihood of having a rotator cuff tear. • B. He will most likely have the same if not better quality of life and sporting activities once rehabilitation starts. • C. He will likely dislocate his shoulder again. • D. All of the above are true

3. 24 year male presents with a traumatic shoulder dislocation that was reduced. He is now 3 days out and in a sling. Which of the following is true? • A. There is a high likelihood of having a rotator cuff tear. • B. He will most likely have the same if not better quality of life and sporting activities once rehabilitation starts. • C. He will likely dislocate his shoulder again. • D. All of the above are true

4. Describe the difference between laxity and instability.

5. Describe the difference between laxity and instability. • Laxity = objective measurement of joint mobility • Instability = subjective symptomatology associated with excessive joint motion.

6. Which of the following are important regarding patient history? • A. Direction of instability. • B. Number of episodes of instability. • C. Both A and B.

7. Which of the following are important regarding patient history? • A. Direction of instability. • B. Number of episodes of instability. • C. Both A and B.

8. The anterior apprehension test is used to test/evaluate what type of instabilty?

9. The anterior apprehension test is used to test/evaluate what type of instabilty? • Anterior instability

10. What test is used in conjunction with apprehension test?

11. What test is used in conjunction with apprehension test? • Relocation test.

12. What special test is used to evaluate posterior instability?

13. What special test is used to evaluate posterior instability? • Jerk test.

14. The sulcus sign evaluates what type of instability?

15. The sulcus sign evaluates what type of instability? • Inferior instability.

16. What anatomic structure is often incompetent when the sulcus sign is present with shoulder ext. rotation?

17. What anatomic structure is often incompetent when the sulcus sign is present with shoulder ext. rotation? • Rotator interval.

18. What x-ray view is paramount for evaluation of shoulder dislocations?

19. What x-ray view is paramount for evaluation of shoulder dislocations? • Axillary lateral.

20. Match the x-ray view with the appropriate pair. • A. West Point • B. Stryker Notch • C. Zanca • 1. Hill-Sachs lesion • 2. Bony Bankart • 3. AC Joint

21. Match the x-ray view with the appropriate pair. • A. West Point – 2. Bony Bankart • B. Stryker Notch – 1. Hill-Sachs lesion • C. Zanca – 3. AC Joint

22. What position of the shoulder reapproximates the anterior labrum anatomically? • Internal rotation (as if in a sling) • Slight flexion • External rotation • Neutral rotation and extension

23. What position of the shoulder reapproximates the anterior labrum anatomically? • Internal rotation (as if in a sling) • Slight flexion • External rotation • Neutral rotation and extension

24. What complications results from nonanatomic reconstructions of the anterior shoulder (Putti-Platt and Magnuson-Stack)?

25. What complications results from nonanatomic reconstructions of the anterior shoulder (Putti-Platt and Magnuson-Stack)? • 1. Significant loss of motion • 2. OA

26. According to a recent study involving the Bristow-Latarjet procedure, what radiograph was the most accurate view for revealing OA?

27. According to a recent study involving the Bristow-Latarjet procedure, what radiograph was the most accurate view for revealing OA? • Subcoracoid projection (angeld inferiorly 45 degrees from above) • The true AP view tended to minimize/miss arthritic changes.

28. What is the first line treatment of multidirectional instability?

29. What is the first line treatment of multidirectional instability? • Aggressive Physical Therapy • Maximize strength and balance of the dynamic stabilizers (cuff, delt, scap) • Patient Education • Activity Modification

30. Match the structure with the appropriate restraint. • A. Posterior Band IGHL • B. Rotator Interval (Coracohumeral and superior GHL) • 1. Posterior restraint with the arm flexed, add, IR. • 2. Posterior restraint with the arm in abd

31. Match the structure with the appropriate restraint. • A. Posterior Band IGHL – resists posterior translation with the arm in abd (A-2). • B. Rotator Interval (Coracohumeral and superior GHL) – Posterior restraint with the arm flexed, ADD, IR (B-1).

32. What procedure is performed after primary anteroinferior instability treatment fails?

33. What procedure is performed after primary anteroinferior instability treatment fails? • Bristow-Latarjet repair • Coracoid to the anterior glenoid rim transfer. • Provides bony reinforcement as well as a soft-tissue sling of conjoined tendons when the arm is abd and ER.

34. Describe the 6 types of AC Joint Separation

35. Describe the 6 types of AC Joint Separation • Type I • Nondisplaced sprain • Type II • Tear AC lig with intact CC lig • Mild clavicular displacement • Type III • Comple tear AC and CC lig • 100% superior displacement of the clavicle • Type IV • Posterior displacement • Type V • 100-300% superior displacement • Type VI • Inferior displacement locked beneath the coracoid

36. What type is basically always treated nonsx?

37. What type is basically always treated nonsx? • Type I

38. Which types basically always get treated with sx?

39. Which types basically always get treated with sx? • Types IV, V, VI

40. What x-ray view is used to help evaluate SC instability?

41. What x-ray view is used to help evaluate SC instability? • Serendipity view • 40 degree cephalic tilt • BUT… CT is accepted as the study of choice.

42. What direction may lead to major vascular/chest injury?

43. What direction may lead to major vascular/chest injury? • Posterior SC dislocations