Recurrent Shoulder Dislocation - Fisiokinesiterapia · Repeat left shoulder dislocation Mechanism...
Transcript of Recurrent Shoulder Dislocation - Fisiokinesiterapia · Repeat left shoulder dislocation Mechanism...
Anatomy of the ShoulderAnatomy of the Shoulder
Shoulder DislocationsShoulder Dislocations
Case StudyCase Study
Rehabilitation Pick ListRehabilitation Pick List
Anatomy of the ShoulderAnatomy of the Shoulder
ArticulationsArticulations
SternoclavicularSternoclavicular
AcromioclavicularAcromioclavicular
ScapulothoracicScapulothoracic
GlenohumeralGlenohumeral
Anatomy of the ShoulderAnatomy of the Shoulder
LigamentsLigaments
Where?Where?What?What?
SternoclavicularSternoclavicular
Anatomy of the ShoulderAnatomy of the Shoulder
LigamentsLigaments
Where?Where?What?What?
Acromioclavicular Acromioclavicular
Anatomy of the ShoulderAnatomy of the Shoulder
LigamentsLigaments
Where?Where?What?What?
GlenohumeralGlenohumeral
Anatomy of the ShoulderAnatomy of the Shoulder
Joint CapsuleJoint Capsule
LooseLooseUnrestricted ROMUnrestricted ROMReinforcedReinforced
Anatomy of the ShoulderAnatomy of the Shoulder
ArticularArticular CartilageCartilage
Covers joint surfacesCovers joint surfacesDeepens glenoid Deepens glenoid fossafossaMinimizes loads and stressMinimizes loads and stress
Anatomy of the ShoulderAnatomy of the Shoulder
Glenoid LabrumGlenoid LabrumDense, fibrous structureDense, fibrous structureOvalOvalDeepens glenoid Deepens glenoid fossafossaStabilityStability
Anatomy of the ShoulderAnatomy of the ShoulderMusculatureMusculature
Motions?Motions? *Stability*StabilityFlexionFlexionExtensionExtensionAbductionAbductionAdductionAdductionHorizontal AbductionHorizontal AbductionHorizontal AdductionHorizontal AdductionInternal RotationInternal RotationExternal RotationExternal RotationCircumductionCircumduction
Anatomy of the ShoulderAnatomy of the ShoulderMusculatureMusculature
Acting on the HumerusActing on the HumerusAnterior Anterior
Pectoralis MajorPectoralis MajorBiceps Biceps BrachiiBrachiiCoracobrachialisCoracobrachialisDeltoidDeltoid
PosteriorPosteriorDeltoidDeltoidTeresTeres MajorMajorLatissimusLatissimus DorsiDorsiTriceps Triceps BrachiiBrachii
http://www.getbodysmart.com/ap/muscularsystem/armmuscles/menu/menu.html
Anatomy of the ShoulderAnatomy of the Shoulder
MusculatureMusculature
Acting on the ScapulaActing on the ScapulaAnteriorAnterior
SerratusSerratus AnteriorAnteriorPectoralis MinorPectoralis Minor
PosteriorPosteriorLevatorLevator ScapulaeScapulaeTrapeziusTrapeziusRhomboideusRhomboideus MajorMajorRhomboideusRhomboideus MinorMinor
http://www.getbodysmart.com/ap/muscularsystem/shouldermuscles/menu/menu.html
Anatomy of the ShoulderAnatomy of the Shoulder
Nerve and Blood SupplyNerve and Blood Supply
Brachial plexusBrachial plexusC5C5--T1T1
SubclavianSubclavian arteryartery
Shoulder DislocationShoulder Dislocation
Fast FactsFast Facts50 % of ALL dislocations50 % of ALL dislocations95 % anterior95 % anterior85 % caused by trauma recur85 % caused by trauma recur
Shoulder DislocationsShoulder Dislocations
Mechanism?Mechanism?Anterior vs. posteriorAnterior vs. posterior
Forced abduction, external rotation, extensionForced abduction, external rotation, extensionForced adduction, internal rotation; FOOSHAForced adduction, internal rotation; FOOSHA
Shoulder DislocationsShoulder Dislocations
Defects following dislocation?Defects following dislocation?
HillHill--SachsSachsSLAPSLAPBankartBankart
Shoulder DislocationsShoulder Dislocations
HillHill--Sachs lesionSachs lesionPosterior lateral aspectPosterior lateral aspectCompressionCompression
Shoulder DislocationShoulder Dislocation
Superior Labrum Superior Labrum AnteroposteriorAnteroposterior Lesion Lesion (SLAP)(SLAP)
10 to 210 to 2Affects bicepsAffects biceps
Shoulder DislocationsShoulder Dislocations
BankartBankart LesionLesionArthroscopic vs. openArthroscopic vs. openAnterior labrumAnterior labrum
Shoulder DislocationsShoulder Dislocations
Chronic Instability Chronic Instability –– Increasing laxity due to repeat Increasing laxity due to repeat
incidents, trauma, genetics, or neuromuscular deficitsincidents, trauma, genetics, or neuromuscular deficits
Signs and SymptomsSigns and SymptomsSportSportClickingClickingPainPainWeaknessWeakness
Shoulder DislocationsShoulder Dislocations
Chronic InstabilityChronic Instability
Signs and SymptomsSigns and SymptomsLaxity Laxity –– Drawer testsDrawer testsApprehensionApprehensionJob RelocationJob RelocationSulcusSulcus
Shoulder DislocationsShoulder Dislocations
Chronic InstabilityChronic Instability
ManagementManagementConservative vs. surgicalConservative vs. surgical
Case StudyCase Study19 year19 year--old male, collegiate catcherold male, collegiate catcherNo previous historyNo previous historyJune 14June 14thth, 2004, 2004Left shoulder dislocationLeft shoulder dislocationMechanismMechanism
Summer ball Summer ball –– Dove awkwardly back to 1Dove awkwardly back to 1stst basebaseReducedReduced
ImmobilizerImmobilizerContacted ATCContacted ATC
Second opinionSecond opinion
Case StudyCase Study
June 17June 17thth, 2004, 2004Seen by Dr. Seen by Dr. TheutTheut –– OrthopaedicOrthopaedic Associates of GRAssociates of GR
IrritableIrritableLimited ROMLimited ROMXX--ray ( ray ( -- ))
Surgery vs. therapySurgery vs. therapyAbduction Abduction slingsling
Case StudyCase StudyFebruary 7February 7thth, 2005, 2005Repeat left shoulder dislocationRepeat left shoulder dislocation
MechanismMechanismTarps following practiceTarps following practice
““Slipped outSlipped out”” & & ““felt like it went out towards the felt like it went out towards the bottombottom””ReducedReduced
ExaminationExaminationLimited ROMLimited ROMSlight swellingSlight swelling(+) Apprehension, Job Relocation, (+) Apprehension, Job Relocation, SulcusSulcus, Anterior , Anterior Load and ShiftLoad and Shift
Case StudyCase StudyApril 2April 2ndnd, 2005, 2005Repeat left shoulder Repeat left shoulder dislocationdislocationMechanismMechanism
High inside fastballHigh inside fastballReducedReducedSurgerySurgery
* * Number of occurrencesNumber of occurrences
Case StudyCase StudyApril 14April 14thth, 2005, 2005Dr. Dr. TheutTheutExaminationExamination
Good ROMGood ROM(+) Apprehension and Job relocation(+) Apprehension and Job relocationNo gross instabilityNo gross instabilityGood strengthGood strengthNo evidence of multidirectional instabilityNo evidence of multidirectional instability
MRIMRISurgical planSurgical plan
Arthroscopic with open optionArthroscopic with open option
Case StudyCase Study
August 16August 16thth, 2005, 2005Arthroscopic Arthroscopic BankartBankart RepairRepair
Left shoulder instabilityLeft shoulder instabilityTear of anterior inferior and superior labrumTear of anterior inferior and superior labrum
http://www.drstoller.com/education_bankart.htmhttp://www.drstoller.com/education_bankart.htm
Case StudyCase StudyRehabilitation Sheet Rehabilitation Sheet ––
August 31August 31stst, 2005, 2005
GoalsGoalsNormal, pain free Normal, pain free ROMROMNormal strength Normal strength Normal Normal arthrokinematicsarthrokinematics and and proprioceptionproprioceptionPain free ADL Pain free ADL Return to full activity Return to full activity
BankartBankart Repair 8/16/05Repair 8/16/05Date: ________Date: ________Pain Scale : 0 1 2 3 4 5 6 7 8 9 10 Pain Scale : 0 1 2 3 4 5 6 7 8 9 10
Goniometry:Goniometry:
TodayToday NormalNormalFlexionFlexion
________________ 180180____ExtensionExtension
________________ 50__50__AbductionAbduction
________________ __180__180__Internal RotationInternal Rotation
________________ __ 9090____External RotationExternal Rotation
________________ __ 9090____Exercises:Exercises:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Comments:Comments:
Case StudyCase StudyRehabilitation ProtocolRehabilitation Protocol
Days 1&2Days 1&2ImmobilizationImmobilizationPendulumPendulumAvoid ext. rot.Avoid ext. rot.Isometrics to distal Isometrics to distal jointsjointsModalitiesModalitiesCardioCardio
Weeks 1Weeks 1--66Sling while upSling while upPROMPROMScapular strengthScapular strengthIsometricsIsometricsModalitiesModalitiesCardioCardio
Case StudyCase StudyRehab Protocol ContinuedRehab Protocol Continued
Weeks 6Weeks 6--1212AROM & PROMAROM & PROMDynamic strengtheningDynamic strengtheningRROMRROMCardioCardio
Weeks 12Weeks 12--2424Increase strengthIncrease strengthIsokineticIsokinetic testingtestingSport specificSport specificReturn to sportReturn to sport
Case StudyCase Study
AthleteAthleteCooperativeCooperativeMotivatedMotivatedEnthusiasticEnthusiasticDid not missDid not miss
Obstacles?Obstacles?
Case StudyCase Study
Returned to play December 12Returned to play December 12thth, 2005, 2005Lifting, overhead activities (bench & military)Lifting, overhead activities (bench & military)
GoalsGoalsPre seasonPre season““Play the whole season without getting hurtPlay the whole season without getting hurt””““Win MIAAWin MIAA””
Rehab Pick ListRehab Pick List
Why should we use/develop rehab pick lists?Why should we use/develop rehab pick lists?
Way to organizeWay to organizeWay to rememberWay to rememberSpecific to your institutionSpecific to your institutionMore interesting for athleteMore interesting for athleteSimple, fast, and effective way to make daily Simple, fast, and effective way to make daily rehab programsrehab programs
In Review:In Review:
Anatomy of the ShoulderAnatomy of the Shoulder
Shoulder DislocationsShoulder Dislocations
Case StudyCase Study
Rehabilitation Pick ListRehabilitation Pick List
Shoulder dislocations Shoulder dislocations WILL happenWILL happen
By knowing the By knowing the anatomyanatomy, , being being familiarfamiliar with these with these
types of injuries, and types of injuries, and developing developing pick listspick lists for for
your rehabilitation programs your rehabilitation programs you will quickly and you will quickly and
effectively return your effectively return your athletes to the games they athletes to the games they
love.love.
ReferencesReferencesPrentice, William E., (2003). Prentice, William E., (2003). ArnheimArnheim’’ss Principles of Athletic Training: Principles of Athletic Training:
A CompetencyA Competency--Based Approach. Based Approach. New York: McGraw Hill.New York: McGraw Hill.
ShoulderDoc.co.ukShoulderDoc.co.uk. (2003). . (2003). Acute Shoulder Dislocations.Acute Shoulder Dislocations. Retrieved Retrieved January 10January 10thth, 2006, from , 2006, from http://www.shoulderdoc.co.uk/index.asphttp://www.shoulderdoc.co.uk/index.asp
Get Smart Body. (2006). Get Smart Body. (2006). Muscular System.Muscular System. Retrieved January 20Retrieved January 20thth, , 2006, from 2006, from http://www.getbodysmart.com/ap/muscularsystem/menu/menu.htmlhttp://www.getbodysmart.com/ap/muscularsystem/menu/menu.html