Understanding shoulder instability

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@theshoulderdoc Lennard Funk UNDERSTANDING SHOULDER INSTABILITY [email protected]

Transcript of Understanding shoulder instability

Page 1: Understanding shoulder instability

@theshoulderdoc

Lennard Funk

UNDERSTANDINGSHOULDER INSTABILITY

[email protected]

mailto:[email protected]
Page 2: Understanding shoulder instability
Page 3: Understanding shoulder instability

@theshoulderdoc

TUBS Range AMBRIraumatic

nidirectional

ankart

urgery

traumatic

ultidirectional

ilateral

ehabilitation

nferiorshift

Page 4: Understanding shoulder instability

@theshoulderdoc

Polar ITraumatic Structural

STANMORE CLASSIFICATION

Polar IIAtraumatic Structural

Polar IIIMotor Control

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@theshoulderdoc

SHOULDER INSTABILITY

L Funk / 2002

Involuntary Voluntary

Traumatic Atraumatic Hyperlaxity

Overuse

Anterior Posterior Multi

Acute Chronic Recurrent

Subluxation DislocationSilliman & Hawkins, 1993

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@theshoulderdoc

SHOULDER INSTABILITY

L Funk / 2002

Involuntary Voluntary

Traumatic Atraumatic Hyperlaxity

Overuse

Anterior Posterior Multi

Acute Chronic Recurrent

Subluxation DislocationSilliman & Hawkins, 1993

HISTORY

EXAMINATION

HISTORY

HISTORY

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@theshoulderdoc L Funk / 2002

CASE 1

Age & Sex: 22yr MaleSemi-Pro Rugby Player

1st Disloc: Rugby Tackle 6 months agorelocated in A&E

Recurrences: 3 recurrences with rugby in ABER relocated each time

Other: Keen to return to rugby, but unable

Traumatic

Recurrent

Polar ITraumatic Structural

Anterior

Dislocation

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@theshoulderdoc L Funk / 2002

CASE 2

Age & Sex: 17yr FemaleDrama Student

1st Disloc: Cannot recall or remember any specific episode

Recurrences: Almost every day for past 4 years‘Slips’ dressing & simple activities

Other: Afraid to perform any frontal activitiesADL severely affected

Atraumatic

Posterior

RecurrentSubluxation

Polar IIIMotor Control

Page 9: Understanding shoulder instability

@theshoulderdoc L Funk / 2002

CASE 3

Age & Sex: 22yr FemaleGymnast

1st Disloc: Painful for 2 years Slipped out whilst training 1 year ago

Recurrences: Painful ‘slipping’ when training

Other: Unable to competeHas generalised hyperlaxity

(A)traumatic

Multidirectional

Recurrent

Subluxation

Polar IIAtraumatic Structural

Page 10: Understanding shoulder instability

@theshoulderdoc

Polar ITraumatic Structural

STANMORE CLASSIFICATION

Polar IIAtraumatic Structural

Polar IIIMotor Control

Small lesion RepairCapsular Plications

Rehab +/-Capsular Plication

Large lesion RepairBony Reconstructions

SpecialistRehab.

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Factors in InstabilityAnju Jaggi

Motor Control & Rotator CuffImbalance / Weakness Co-activation

Chain ineffective for normal RC recruitment

Scapula Dyskinesis Poor Kinetic Chain

Structural insufficiency

Capsulolabral damage Hyperlaxity

Fear AvoidanceBelief Disuse

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@theshoulderdoc

Recurrence rate > 70%under 20

Sports - level & type

male

Significant lesions

Large Hill-Sachs

Bony Bankart

ALPSA

HAGL

SURGERY:

Simonet, 1984Wheeler, 1989Arciero, 1994Burkhart, 2001Larrain, 2006Mologne, 2007Porcellini, 2009

Page 13: Understanding shoulder instability

@theshoulderdoc L Funk / 2002

CASE 1Age & Sex: 22yr Male

Semi-Pro Rugby Player

1st Disloc: Rugby Tackle 6 months agorelocated in A&E

Recurrences: 3 recurrences with rugby in ABER relocated each time

Other: Keen to return to rugby, but unable

MR Arthrogram Bony Bankart lesion & HAGL

Traumatic

Recurrent

Polar ITraumatic Structural

Anterior

Dislocation

Large lesion RepairBony Reconstructions

Page 14: Understanding shoulder instability

@theshoulderdoc L Funk / 2002

CASE 2Age & Sex: 17yr Female

Drama Student

1st Disloc: Cannot recall or remember any specific episode

Recurrences: Almost every day for past 4 years‘Slips’ dressing & simple activities

Other: Afraid to perform any frontal activitiesADL severely affected

MR Arthrogram Normal

Atraumatic

Posterior

RecurrentSubluxation

Polar IIIMotor Control

SpecialistRehab.

Page 15: Understanding shoulder instability

@theshoulderdoc L Funk / 2002

CASE 3Age & Sex: 22yr Female

Gymnast

1st Disloc: Painful for 2 years Slipped out whilst training 1 year ago

Recurrences: Painful ‘slipping’ when training

Other: Unable to competeHas generalised hyperlaxity

MR Arthrogram Small, rounded antero-inferior labrum

Capacious capsule

(A)traumatic

Multidirectional

Recurrent

Subluxation

Polar IIAtraumatic Structural

Rehab +/-Capsular Plication

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@theshoulderdoc

Polar ITraumatic Structural

FINAL SUMMARY

Polar IIAtraumatic Structural

Polar IIIMotor Control

(A)traumatic

Recurrent

Subluxation

Traumatic

Anterior/ Posterior

Dislocation

Atraumatic

Posterior

RecurrentSubluxation

Rehab +/-Capsular Plication

SpecialistRehab.

Large lesion RepairBony Reconstructions

Page 17: Understanding shoulder instability

Factors in InstabilityAnju Jaggi

Motor Control & Rotator CuffImbalance / Weakness Co-activation

Chain ineffective for normal RC recruitment

Scapula Dyskinesis Poor Kinetic Chain

Structural insufficiency

Capsulolabral damage Hyperlaxity

Fear AvoidanceBelief Disuse

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@theshoulderdoc

THANK YOU

@OrthTeam @theshoulderdoc #therapyexpo


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