Title: Recurrent Instability of the Shoulder Joint
1Recurrent Instability of the Shoulder Joint
Dr. Rami Eid
2?????
- ????? ?? ?????? ????? ??????
- ????? ?? ?????? ?????? ?????? ????? / 50 ?? ????
???? ??????? / - ??? ????? ?? ?????? ????? ( ??? ??????? ???????
????? ?????? ?????? ???????? ??? ?????? ...) - ???? ????? 90 ??? ?? 20 ???? 60 ??? 20 ? 40
???? 10 ??? ?? 40 ???
3Functional Anatomy
- ????? ??????? ???? ????? ??? ????? ???? ?????
- ?? 25 ??? ?? ????? ????? ??????? ?????? ?? ???
?????
4Functional Anatomy
- ?????? Labrum
- ???? ?? ??? ????? ??????? ????? 50 ??? ????
?? ?????? ?? ??? ????? ????? 75 - ????? ???????? ?? ????? ?????? ??? ?????
????? ?????? ???? ???????
5Functional Anatomy
6Functional Anatomy
- ???????
- ??? ???? ????? ??? ????? ??????? ?? ????????
- ????? ?? ????? ???????? ?????? ?????
7Functional Anatomy
- ???????
- SGHL
- MGHL
- IGHL ??? ?????
8Superior Glenohumeral Ligament
- ???? ?? ??? ?????? ?????? ??? ????? ????????
- ?? ?????? 0 ?? ??????? ???? ?????? ??????
- ?? ????? ???? ?????? ??????
9Middle Glenohumeral Ligament
- ???? ?? ?????? ???????? ?????? ??? ????????
?????? ??????? ?????? ??? ????? ???????? - ????? ?? ????? ??????? ??????? ?? ??????? ??????
?? ???????
10Inferior Glenohumeral Ligament Complex
- ???? ??? ????? ?????? ??????? ???? ??? ??????
??????? - ????? ??? ????? ?????? ???? ????? ????????
???????? - ????? ?? ???? ?????? ????? ????? ???? ???? ????
??????? - ???? ????? ?????? ???? ????? ????? ???????
????????
11???? IGHL
12Axillary Pouch
13IGHL in abduction rotation
14??????? ?? ??? ?????
- ?????? ??????? ?????? ?? ??? ??? ?????
- ?????? ???? ??????
- Subscapularis
- Supraspinatus
- Infraspinatus
- Teres minor
15??????? ?????????????? ??????? ?? ????????
- Passive factors
-
- Active factors
16Passive Factors
- ????? ?????? ???? ????? ????? ?????? ???? ??? ??
????? ?????? - ????? ?????? ??? ????? ??????? ???? ??????? ??
???? ??? ?? 1 ?? ?? ?????? (??????? ????????) - ???????? ?????? ?? ????? ??????? ?????? ????????
???? ?? ????????
17Passive Factors
18Passive Factors
- ?????? ?????? ??? ????? (????? 1/3 ???? ????
?????) ???? ????? ??? ????? ??????? ????? - ???? ?????? Paccini, Ruffini ??? ??????? ????
????? ?? ???????? ??????? ????????
19Active Factors
- ????? ?????? ???? ??????? ????? ?????? ???? ????
????? ??? ????? - ??????? ???? ??? ?????? ????? ??? ????? ?? ??????
0 ?? ??????? - ??????? ??????? ???? ???? ????? ????? ??????? ???
??? ????? ?????? ?????
20????????? ????????? ???????
21????????? ????????? ???????
- Bankart lesion
- - ?? ???? ??????? ????????
- - ???? ????? ????
22Bankart lesion
23????????? ????????? ???????
- Hill-Sachs
- - ??? ??????? ?? ??? ????? ?? ??????? ????????
?????? ???????? ????? - - ???? ?? ????? ???????
- - ???? ????? ??? ?????? ?? ????? ??????? ???????
?? ???????
24Hill-Sachs lesioninternal, external rotation,
axillary view
25????????? ????????? ???????
- ????? ????????? ?? ?????? ??????? ???? ??? ?????
1/3 ????? ????? ??????? ????? ??? ??????? - ???? ???? ?????? ??? ??? 80 ?? ????? ?????
?????? ??? 60 ???
26Classification
- The Direction
- Unidirectional
- Bidirectional
- Multidirectional
-
27Classification
- Type of trauma
- 1- Macrotraumatic???? ??? ????
- 2- Microtraumatic (acquired)
- ???? ????? ??????? ???? ????? plastic deformation
?? ??????? ??????? ????? ?????? (??? ?????????)
28Classification
29(No Transcript)
30Classification
- ????? ??????? ???? ?????? ????? ?????? ?????
- ????? ?????? ???? ???????? ? ??????? ??????? ??
??? ????? ????? ???? ?? ????? ????? ? ???????
?????????? - Luxatio Erecta ???? ??? ??????? ? ????? ??????
????? 110 160 ???? - ????? ?????? ?????? ????? ?? ????? ??????? ????
?????
31Anterior Dislocation(Subcoracoid)
32Anterior Dislocation(Subglenoid)
33Anterior Dislocation(Subclavicular)
34Posterior Dislocation(Subacromial)
35Posterior Dislocation(subspinous)
36Inferior Dislocation(Luxatio Erecta)
37???????
38???????????? ???????
- ?????? ????? ??? ?????? ??? ?????
- ???? ????? ??? ????? ???? ??????
- ??? ??????
- ????? ??????? ??????? ??????? ?????
- Generalized Hyperlaxity
- ????? ???? ????????
39Generalized Hyperlaxity
40???????? ????? ???? ????????
- Drawer test
- ???? ??? ????? ???????? ??????? ?? ?????? 0 ??
???????
41???????? ????? ???? ????????
- Sulcus test
- ??? ?????? ??????? 0 (????? ???? ??????) ? 45
(????? IGHL ) - ?? ????? 1 (??? ?? 1 ??)
- 2 (1-2 ??)
- 3 (???? ?? 2 ??)
42???????? ????? ???? ????????
43???????? ????? ???? ????????
- Lachman test
- Anterior stress (1 ????,2 ??? ? ????,3 ??? ???)
- Posterior stress
44???????? ????? ???? ????????
- Jerk test
- ??? ?????? ?????
45???????? ????? ???? ????????
- Push Pull test
- ??? ?????? ?????
46???????? ????? ???? ????????
- ?????? ??? ????? ????? ?????? (Atraumatic
dislocation) - ????? ????? ?????? ???????
47Radiographic Evaluation
- A-P view in the plane of the body
- True A-P view in the plane of scapula
- Lateral view in the plane of scapula
- Axillary view
48A-P view
49A-P view
50Lateral View
51Axillary view
52Radiographic Evaluation
- A-P view
- ????? ????? ?????? ??????? ??????? ????? ?? ???
????? ??????
53Radiographic Evaluation
- True A-P view
- ?? ???? ??????? ???? ???? ???
54Radiographic Evaluation
- Lateral view
- ???? ?? ????? ????? ????? ????? ?? ????
55Radiographic Evaluation
- Axillary view
- ???? ?? ????? ???? ??????? ? ????? ???????
56????????? ????
- CT, 3D CT ?????? ???? ????? ???????? ?????? ???
????? ?????? ????? ?????? ????? - MRI ?? ??? ?? Gadolinium ?????? ??????? ???????
?????? ???? ?????? - ??????? ???? ?? ????? ?????? ?????? ???? ?????
??? ??? ??????
57?????? ??????? ?? ??? ???????? ????????
58Bankart Operation
- ????? ????? ???????
- - ??? ??????? ? ?????? ??? ????? ?????
- - ????? ??????? ??? ???? ????? ?? ?? ??????
- - ????? ????? ??????
59Bankart Operation
60Bankart Operation
- ?????????
- ????? ?????? ?????? ???????? ?? ???? ?????
??????? - TUBS Macro or Micro traumatic
- ??? ?????? ?????? ????? ?????? (Microtraumatic
Sulcus testlt2 )
61Bankart Operation
- Rehabilitation program for anterior capsulolabral
reconstruction - POSTOPERATIVE PERIOD (0-3 WEEKS)
- Brace or abduction pillow
- Passive/active ROM abduction (90 degrees),
flexion (90 degrees), and external - rotation (45 degrees) no extension
- Isometric abduction, horizontal adduction, and
external rotation - Elbow ROM
- PHASE I (3-6 WEEKS)
- Progress passive and active ROM, protecting
anterior capsule - Active internal rotation (full) and external
rotation (neutral) - PHASE II (6 WEEKS - 3 MONTHS)
- Continue ROM, gradually increasing external
rotation (goal is full ROM by 2 months) - Add shoulder flexion and horizontal adduction
exercises - PHASE III (3-6 MONTHS)
- Add push-ups (begin with wall push-up with body
always posterior to elbows)
62Bristow Operation
- ????? ????? ???????
- 1- ??? ?????? ??????? ??? ????? ??????? ?????? ??
????? ??????? - 2- ???? ?????? ??????? ???? ???? ????? ???? ??
5 ?? - ???? ?? ??????
????? - ???? ?????? ???
????? ?????? - ???? ??????
63Bristow Operation
64Bristow Operation
- ?????????
- ??? ????? ??????? ???? ????? ?????
- ???? ?????? ??????
- ??? ??? ???????? ??? ???? ????? ??????? ???????
65Bristow Operation
- After Treatment
- ???????? ???? ????? ?? ??? ?????? ??? ???? 6
?????? - ???? ???????? ??? ?? 50 75 ?? ???????
66Weber Subcapital Osteotomy
67Capsular Shift Procedure For Multidirectional
Instability
68Neer Technique
- ?????????
- AMBRI ??? ?????? ?????? ??????? ?? ??? ??????
????? Sulcus 2,3 - ????? ?? ????? ?? ???? ??? ???? ?????
69Neer Technique after treatment
- 10 days gtgt 90 flexion
- 4 weeks gtgt 140 flexion 30 ext rot
- 5 weeks gtgt 160 flexion 40 ext rot
- 6 weeks gtgt 180 flexion 50 ext rot
70?????? ??????? ?? ??? ???????? ???????
71??????????? ????????
- ??? ?????? ??????? ???? 4 6 ??????
- ???? ???? ?? ??????? ???????
- ????? ?????? ????? ??????
72??????? ????????
73??????? ????????
74(No Transcript)
75MoKazem.com
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??????? ?? ???? ????, ??? ????? ?. ???? ??????. - ?????? ??? ????? ?? ??????? ??????? ?? ???
????????. - This lecture is one of a series of lectures were
prepared and presented by residents in the
department of orthopedics in Damascus hospital,
under the supervision of Dr. Bashar Mirali. - This site is not responsible of any mistake may
exist in this lecture.
?. ???? ????
Dr. Muayad Kadhim