shoulder instablity pptx - وحيد

• Shoulder Instability

• By
• Ass. Proff.
• Dr. Wahid M. Hassan

DEFINITION:

Glenohumeral instability is the inability to maintain the humeral head in the glenoid fossa.

Glenoid Labrum

Static stabilizer
contributes 20% to GH stability
fibrous tissue
deepens glenoid(50%), 9mm sup/inf, 5mm AP
3purposes:
increases surface contact area
butress
attachment site for GH ligaments

Biomechanics of GH stability

the normal shoulder precisely constrains the humeral head to the center of the glenoid cavity throughout most of the arc of movement.

Static restraints

negative intra-articular pressure
ligaments and capsule
labrum (increases concavity)
articular surfaces/osseous anatomy
(very little because square area of humeral head is 3X glenoid)
joint fluid adhesiveness
suction cup
limited joint volume

Dynamic restraints

Rotator cuff muscles
deltoid and biceps
concavity compression

Types of instability

Congenital
Acute
Chronic
Recurrent
Traumatic
Atraumatic

Evaluation of recurrent traumatic dislocations
Injury to capsule, rot cuff, labrum, glenoid, humerus.
Young (14-34)
Male

History

HX of 1st dislocation or injury
Subsequent dislocations/subluxations

X-RaysIdentify Bankart, Hill-SachsMRIUltrasoundArthroscopy

Diagnosis

TREATMENT
Recurrent Traumatic Ant. Dislocation
Surgical stabilization
Open or arthroscopic
Poor response to non operative tx

• Atraumatic Instability

• 80% respond to physio
• Surgical stabilization - capsulorraphy if non - operative fails.
TREATMENT

• Voluntary or Habitual
• Retrain muscles
• No surgery
TREATMENT

THE Elbow ,Wrist & Hand: Evaluation and Treatment of Common Disorders

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Tennis Elbow / Lateral Epicondylitis

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Definition
Tennis Elbow Defined:
Tennis elbow is an overuse injury of the elbow joint. It is commonly found in tennis and golf players, especially the “weekend warrior” type. The medical term for tennis elbow is lateral epicondylitis or radiohumeral bursitis

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Anatomy
The elbow joint is made up of the following bones, muscles and ligaments.
Humerus, Radius and Ulna.
Bicep and Tricep.
Lateral and medial epicondyle.
Wrist flexor and extensor muscles.
Ulna collateral ligament.

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A Detailed View of the Elbow

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How Tennis Elbow Occurs
Tennis elbow is an overuse injury. The most common mechanism of injury is continuous forceful extension of the wrist with pronation of the forearm. This movement is most typically seen in the backhand stroke of tennis and in the downswing portion of a golf swing.

Tendinosis

Mucoid degeneration

Loss of collagen tight bundled structure

Fibrosis

Neo-vascularisation

(Khan et al. 1999)

12/24/2016
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Prevalence
Tennis elbow is found to have an impact on 1-3% of the general population.
Most commonly affecting men and women from the ages of 40-50 years of age.
However, tennis elbow can still present itself in people of all ages who are not properly condition to perform the activities which will tend to cause this injury. Examples are the weekend golf and tennis players who are not commonly active.

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Symptoms and Signs
Pain along the lateral epicondyle while performing wrist extension against resistance.
Point tenderness to joint and musculature.
Loss of normal range of motion and function.
Difficulty opening door handles
Difficulty shaking hands