The Shoulder Part II

1
The ShoulderPart II

• Age lt 40

2
Instability

• Traumatic
• it aint out unless its out
• Xray proof needed
• Atraumatic

3
Shoulder Dislocation
4
Symptoms

• Pain in the front of the shoulder
• Pain with shoulder in position of instability
  (abduction and external rotation)
• Apprehension test

5
Apprehension Test

• Start with abduction, no rotation. Gently add
  External
  Rotation
  

6
Traumatic Instability

• gt98 are anterior (dislocated with arm in some
  combination of abduction/external rotation)
• Neurovascular injury is rare
• Initial tx shoulder immobilizer (4weeks), refer
  to Ortho and PT
• Beware patients gt 50 yo (RCT is common)
• Surgery if recurrent

7
Where does velocity come from
8
Atraumatic Instability

• Repetitive microtrauma in a position of
  instability (ABD/ER) swimmers, throwers, weight
  lifters. Secondary impingement
• Anterior capsule is slowly being stretched.
• Tx PT to strengthen anterior rotator cuff
  (subscapularis) for muscle repair and restrict
  offending activities

9
Shoulder Injury

• Can be major pain after minor injury
• Pain limits active shoulder motion, not rotator
  cuff tear
• Exclude a fracture AP/lateral radiographs

10
Shoulder Injury, normal xray

• Tender deltoid muscle contusion
• Neuro symptoms traction to brachial plexus
• Test rotator cuff to prove it works (just need to
  feel tension)
• Treatment Sling, ice, analgesic, PT in 2-3 weeks