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Chapter 13: The Shoulder and Upper Arm

Chapter 13: The Shoulder and Upper Arm. Pages 463 - 470. Question #1. Describe the passive and dynamic stabilizers of the GH joint. Glenohumeral Instability. Passive stabilizers GH ligaments (superior, middle, inferior) Joint capsule Coracohumeral ligament Dynamic stabilizers

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Chapter 13: The Shoulder and Upper Arm

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  1. Chapter 13: The Shoulder and Upper Arm Pages 463 - 470

  2. Question #1 • Describe the passive and dynamic stabilizers of the GH joint

  3. Glenohumeral Instability • Passive stabilizers • GH ligaments (superior, middle, inferior) • Joint capsule • Coracohumeral ligament • Dynamic stabilizers • Rotator cuff muscles • Other GH musculature

  4. Question #2 • Describe the mechanism of injury for: • Anterior instability • Posterior instability • Multidirectional instability

  5. Mechanism of Injury • Anterior instability • Repetitive microtrauma • External rotation and 900 abduction • Posterior instability • Repetitive microtrauma • Longitudinal force on humerus, internal rotation, GH flexion 900, horizontal adduction • Multidirectional instability • Typically External rotation and 900 abduction

  6. Question #3 • Describe the pain characteristics associated with: • Anterior instability • Posterior instability • Multidirectional instability

  7. Pain Characteristics • Anterior instability • ADLs • “loose”; abduction w/external rotation • Posterior instability • ADLs • “unstable”; brought across body • Multidirectional instability • ADLs • “loose”; extremes of rotation motions

  8. Question #4 • Describe a Bankart lesion

  9. Bankart Lesion • GH ligament avulsed along with a portion of the labrum • Difficult to identify clinically • Pain, crepitus as humeral head moves against anterior labrum during GH glide testing, shift and load testing, or external rotation of humerus

  10. Question #5 • Describe the Apprehension test for anterior instability • Describe the Relocation test for anterior instability

  11. Apprehension Test

  12. Relocation Test

  13. Question #6 • Describe a Hill-Sachs Lesion and reverse Hill-Sachs Lesion

  14. Hill-Sachs Lesion • Small defect – posterior humeral head’s articular cartilage • Caused by impact of humeral head on glenoid fossa as humerus attempts to relocate after anterior dislocation • Used as diagnostic tool • Rarely symptomatic; may lead to early degeneration of GH joint

  15. Question #7 • Describe the Posterior Apprehension Test for GH Laxity • Describe the Test for Posterior Instability in the plane of the Scapula

  16. Posterior Apprehension Test

  17. Test for Posterior Instability in the plane of the Scapula

  18. Question #8 • Describe the Sulcus Sign for Inferior GH Laxity • What differentiates this test from the AC Traction Test?

  19. Sulcus Sign

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