Risk Factors Participation in Sports Micro-trauma secondary to
shear force directed at the glenoid and labrum Trauma Force
translating the humeral head relative to the glenoid Anterior /
Posterior Shoulder Instability Increased risk secondary to
increased translation of humeral head Glenoid Dysplasia A bone
deficiency of the posteroinferior glenoid rim and hypertrophy of
surrounding cartilage can increase risk of tear from shear
forces
Slide 7
Symptoms Catching, clicking, locking, popping, grinding
Decreased ROM Loss of strength Ache Pain with overhead activities
Pain with axial loading Feeling of instability
(dislocation/subluxation)
Slide 8
Symptoms: -catching, clicking, popping, locking, grinding -
deep shoulder pain - pain w/OH activity - pain w/axial loading -
sense of instability - decreased ROM - decreased MMT Labral (rule
in): -Biceps Load Test I - Biceps Load Test II - Internal Rotation
Resistance Test - Kim test - Jerk test Instability (rule out) -
Apprehension Test - Apprehension/Relocation Test Impingement (rule
out) -Hawkins-Kennedy - Neer - Horizontal Adduction - Yocum RTC
(rule out) -Empty can -Drop sign -Painful arc -ER Lag sign History:
-Young OH athlete (throwing injury) - compressive or distraction
force on the shoulder - fall onto outstretched hand or elbow w/GH
jt adducted and extended traumatic injury that involves substantial
forces on the GH joint
Slide 9
Take Home Message When examining a patient with suspected
labral tear it is important to understand the anatomy and
biomechanics of the shoulder as well as associated risk factors and
mechanisms of injury. Knowledge of this information, in combination
with the patient profile will help to determine the direction to
take upon objective exam of the patient. This algorithm can be used
to test applicable hypotheses after the subjective exam and will
help to guide a thorough yet efficient objective exam.
Slide 10
References Cleland, J.A., Koppenhaver, S. (2011). Netters
Orthopaedic Clinical Examination: An Evidence-Based Approach. 2 nd
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Shoulder Complex. Orthopaedic: Examination, evaluation, &
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(2008). The Shoulder Complex. Orthopaedic examination, evaluation,
and intervention (2nd ed., pp. 405-519). New York: McGraw-Hill
Medical. Escobedo, E.M., Richardson, M.L., & Schulz, Y.B.E.
(2007). Increased Risk of Posterior Glenoid Labrum Tears in
Football Players. American Journal of Roentgenology, 188 (1),
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Football Players Guanche, C.A., Jones, D.C. (2003) Clinical Testing
for Tears of the Glenoid Labrum. Arthroscopy: The Journal of
Arthroscopic and Related Surgery, 19 (5), 517-523. Harper, K. W.,
Helms, C. A., Haystead, C. M., Higgins, L. D. (2005). Glenoid
Dysplasia: Incidence and Association with Posterior Labral Tears as
Evaluated on MRI. American Journal of Roentgenology, 184 (3),
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Posterior Labral Tears as Evaluated on MRI Luime, J.W., Verhangen,
A.P., Miedema, H.S., Kuiper, J.I., Burdorf, A., Verhaar, J.A.N.,
Koes, B.W. (2004) Does This Patient Have an Instability of the
Shoulder or a Labrum Lesion? Journal of the American Medical
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"The Validity and Accuracy of Clinical Tests Used to Detect Labral
Pathology of the Shoulder A Systematic Review." Manual Therapy14.2
(2009): 119-30. ScienceDirect. Web. 21 Apr. 2013. Nam, E. K., &
Snyder, S. J. (2003). Clinical Sports Medicine Update. The
Diagnosis and Treatment of Superior Labrum, Anterior and Posterior
(SLAP) Lesions. The American Journal of Sports Medicine, 31(5),
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Retrieved April 17, 2013, from
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