Perrin, PhD, ATC Injuries of the shoulder complex and upper arm The shoulder joint is particularly susceptible to injuries because of its great mobility and inherent instability. The heavy reliance on soft tissue structures and balanced muscular control for stabilization through a large ROM places considerable demands on these structures, resulting in both acute and chronic injuries. Injury recognition is sometimes difficult because of the interplay of the muscles acting on the shoulder during functional activity.
Shoulder instability is a common pathology encountered in the orthopedic and sports medicine setting. There exists a wide range of symptomatic shoulder instabilities from subtle recurrent subluxations to traumatic dislocations. Nonoperative rehabilitation is commonly utilized for shoulder instability to regain previous functional activities through specific strengthening exercises, dynamic stabilization drills, neuromuscular training, proprioception drills, scapular muscle strengthening program and a gradual return to their desired activities.
But to truly understand shoulder instability, there are several key factors that you must consider. Key Factors When Designing Rehabilitation Programs for Shoulder Instability Because there are so many different variations of shoulder instability, it is extremely important to understand several factors that will impact the rehabilitation program.
This will allow us to individualize programs and enhance recovery. There are 6 main factors that I consider when designing my rehabilitation programs for nonoperative shoulder instability rehabilitation. Factor 1 — Chronicity of Shoulder Instability The first factor to consider in the rehabilitation of a patient with shoulder instability is the onset of the pathology.
Pathological shoulder instability may result from an acute, traumatic event or chronic, recurrent instability. The goal of the rehabilitation program may vary greatly based on the onset and mechanism of injury.
Following a traumatic subluxation or dislocation, the patient typically presents with significant tissue trauma, pain and apprehension.
The patient who has sustained a dislocation often exhibits more pain due to muscle spasm than a patient who has subluxed their shoulder.
Furthermore, a first time episode of dislocation is generally more painful than the repeat event. The primary traumatic dislocation is most often treated conservatively with immobilization in a sling and early controlled Rehabilitation for anterior glenohumeral subluxation range of motion ROM exercises especially with first time dislocations.
Therefore, the rehabilitation program should progress cautiously in young athletic individuals. Individuals between the ages of 19 and 29 years are the most likely to experience multiple episodes of instability. Conversely, a patient presenting with atraumatic instability often presents with a history of repetitive injuries and symptomatic complaints.
Often the patient does not complain of a single instability episode but rather a feeling of shoulder laxity or an inability to perform specific tasks. Rehabilitation for this patient should focus on early proprioception training, dynamic stabilization drills, neuromuscular control, scapular muscle exercises and muscle strengthening exercises to enhance dynamic stability due to the unique characteristic of excessive capsular laxity and capsular redundancy in this type of patient.
Chronic subluxations, as seen in the atraumatic, unstable shoulder may be treated more aggressively due to the lack of acute tissue damage and less muscular guarding and inflammation. Rotator cuff and periscapular strengthening activities should be initiated while ROM exercises are progressed.
Caution is placed on avoiding excessive stretching of the joint capsule through aggressive ROM activities.
|Biomechanics of Swimming||His father was a pioneer Oklahoma Territory Physician and Surgeon and his grandfather was also a physician.|
|Examine injuries of the shoulder joint||TMJ syndrome Prolotherapy could also contribute to the treatment of hypermobility disorders by preventing the development of precocious osteoarthritis.|
|Charles S. Neer Award | American Shoulder And Elbow Surgeons||Signs and symptoms[ edit ] Significant painsometimes felt along the arm past the shoulder. Sensation that the shoulder is slipping out of the joint during abduction and external rotation.|
|CHIROPRACTIC REHABILITATION DIPLOMATE INFORMATION PAGE||Based on subjective observations, the LBP subjects were more likely to fulcrum about the hip and back to maintain uprightness in challenging balance tasks compared with healthy controls who maintained their fulcrum for the COF around the ankle.|
The goal is to enhance strength, proprioception, dynamic stability and neuromuscular control especially in the specific points of motion or direction which results in instability complaints.
Factor 2 — Degree of Shoulder Instability The second factor is the degree of instability present in the patient and its effect on their function. Varying degrees of shoulder instability exist such as a subtle subluxation or gross instability.
The term subluxation refers to the complete separation of the articular surfaces with spontaneous reduction. Conversely, a dislocation is a complete separation of the articular surfaces and requires a specific movement or manual reduction to relocate the joint. This will result in underlying capsular tissue trauma.
Speer et al have reported that in order for a shoulder dislocation to occur, a Bankart lesion must be present and also soft tissue trauma must be present on both sides of the glenohumeral joint capsule.
Thus, in the situation of an acute traumatic dislocation, the anterior capsule may be avulsed off the glenoid this is called a Bankart lesion — see pictures to the right and the posterior capsule may be stretched, allowing the humeral head to dislocate.
For example, a patient with mild subluxations and muscle guarding may initially tolerate strengthening exercises and neuromuscular control drills more than a patient with a significant amount of muscular guarding. Factor 3 — Concomitant Pathology The third factor involves considering other tissues that may have been affected and the premorbid status of the tissue.
As we previously discussed, disruption of the anterior capsulolabral complex from the glenoid commonly occurs during a traumatic injury resulting in an anterior Bankart lesion.
But other tissues may also be involved. Occasionally, a bone bruise may be present in individuals who have sustained a shoulder dislocation as well as pathology to the rotator cuff. In rare cases of extreme trauma, the brachial plexus may become involved as well.
Other common injuries in the unstable shoulder may involve the superior labrum SLAP lesion such as a type V SLAP lesion characterized by a Bankart lesion of the anterior capsule extending into the anterior superior labrum.
These concomitant lesions will affect the rehabilitation significantly in order to protect the healing tissue.
Factor 4 — Direction of Shoulder Instability The next factor to consider is the direction of shoulder instability present. The three most common forms include anterior, posterior and multidirectional.Through educational program's and by encouraging research, ASES seeks to foster and advance the science and practice of shoulder and elbow care.
This page contains Chapter 11 of the text Chiropractic Posttraumatic Rehabilitation UPDATED leslutinsduphoenix.com Injuries of the shoulder complex and upper arm. The shoulder joint is particularly susceptible to injuries because of its great mobility and inherent instability.
Joint Hypermobility Syndrome (JHS) is a largely under-recognized and poorly understood multi-systemic hereditary connective tissue disorder which manifests in a variety of different clinical presentations.
(OBQ) A year-old female volleyball player presents 1 week after sustaining a knee injury while landing from a jump. There was an audible popping sound at the time of injury and she developed swelling later that evening.
Member has joint stability to bear weight on upper and lower extremities, and has balance and control to maintain an upright posture independently; and.