Re: Re: Shoulder Dislocation Rehab

[Guest guest]

Thanks for the replies everyone.

Lowry, DC

Dr. Lowry, LLC

1220 Knox Abbott Drive

Suite D

Cayce, SC 29033

USA

[Mod: The following resource may also be useful:

http://www.aafp.org/afp/990515ap/2773.html

Shoulder Instability in Young Athletes

L. Mahaffey, M.D & A. , M.D.

The term " shoulder instability " constitutes a spectrum of disorders that

includes dislocation, subluxation and laxity. Anterior instability is the most

common form of glenohumeral instability and may be associated with dislocation

or subluxation....

Scapular stability is an important factor in the overall stability of the

shoulder, much like the foundation of a building. The long head of the biceps

tendon, which attaches superiorly on the glenoid labrum, is also a stabilizer

but may not be truly dynamic. The primary function of the rotator cuff is to

maintain the humeral head in the glenoid fossa throughout the shoulder's range

of motion. The rotator cuff accomplishes this function through eccentric

actions, with the muscles maintaining their strength while they lengthen during

movement of the joint.

The glenoid labrum and the joint capsule serve as the static stabilizers by

deepening the glenoid fossa and maintaining negative intra-articular pressure of

the joint. The superior, middle and inferior glenohumeral ligaments attach to

the labrum, and their function is very important for glenohumeral static

stability...

Types of Instability

Attempts have been made to classify different types of shoulder instability,

according to degree of laxity, frequency of symptoms and specific anatomic

lesion. Classifying instability by direction (i.e., anterior, posterior or

multidirectional), however, is helpful in understanding the cause of the

instability and in formulating the approach to diagnostic testing and treatment.

This system is used by most orthopedic surgeons and primary care physicians

specializing in sports medicine......

Anterior Instability

Anterior instability, the most common type of glenohumeral instability, can be

due to either dislocation or subluxation. As many as 85 to 95 percent of all

shoulder dislocations occur anteriorly. Men aged 18 to 25 years are most

susceptible to this injury. Anterior glenohumeral injuries usually occur when

the shoulder is in abduction and external rotation, the weakest position of the

glenohumeral joint biomechanically. It has been termed the " classic position "

for anterior instability.

Anterior dislocations occur equally in dominant and nondominant extremities;

associated rotator cuff tears are infrequent before age 40.6 A patient with

anterior dislocation presents holding the arm in slight abduction and internal

rotation and reports pain with any attempt to rotate the arm. A mass may be

palpable over the anterior shoulder. The patient may also report transient loss

of sensation, and numbness and tingling of the involved extremity, termed the

" dead arm " syndrome. This syndrome may also occur with subluxation. Axillary

nerve injury is not unusual with anterior dislocations. Typically, axillary

nerve injury is manifested by loss of sensation over the lateral deltoid as well

as decreased strength of the deltoid.

Anterior subluxation is common in patients who have had an acute dislocation.

Subluxation may also become a problem secondary to overuse microtrauma and

underlying rotator cuff weakness, a common mechanism of injury in baseball

pitchers.... ]]

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--- icp328 wrote:

> ---

> Hi !

>

> Initially you concentrate on re-establishing proper

> range of motion.

> When that is accomplished you can work on shoulder

> flexion, abduction,

> prone abduction, external/internal rotation,

> protration, and diagonal

> patterns with dumbells, tubing, and/or cables.

> Unfortunately chronic

> dislocators often ( about 90% of the time ) require

> surgery to correct

> labral damage when therapy fails.

>

> Best wishes!

>

> Dan Wathen, Youngstown (OH) State University, USA

[Guest guest]

,

Well like I said, he's a farm boy. The only reason I

even know about his shoulder problem is that his wife

nagged him to send me an email. I have yet to get

specifics as he couldn't adequately tell me much over

the phone. Unfortunately I only see him a couple of

times a year. I know that originally he was seen in

an ER. He has a history of bull riding, but his

shoulder dislocated somehow doing manual labor. Since

then it has dislocated several times and spontaneously

reduced immediately afterwards. He has started

lifting weights over the last few weeks and it sounds

like the shoulder is aggravated by exercises that

target the rhomboids.

Shoulders are not my area of expertise and I'm not

going to see him very often anyway, so I'm going to

tell him to try some conservative care with a good PT

in his neighborhood and see where that leads.

Lowry, DC

Dr. Lowry, LLC

1220 Knox Abbott Drive

Suite D

Cayce, SC 29033

USA

--- Ooch wrote:

> There a number of recommendations I could make but

> it's tough to

> say w/out further details, such how was his shoulder

> dislocated and

> type of treatment he had just afterwards.

>

> Also, you mention that it's " a recurring problem " .

> It'd help also to

> be a little more specific(perhaps only your brother

> can really say).

> If it's a recurring dislocation, surgery may be the

> best option since

> he's probabaly a young active guy. There's also some

> taping techniques

> that could help him maintain some stability during

> physical

> activity ... a reputable physical therapist or ortho

> should be able to

> help him w/ that.

>

> Hope I helped and best of luck to him.

>

> Crawford

> Washington, DC