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Recurrent Instability of the Shoulder Joint

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Title: Recurrent Instability of the Shoulder Joint


1
Recurrent Instability of the Shoulder Joint
Dr. Rami Eid
  • 03/05/2005

2
?????
  • ????? ?? ?????? ????? ??????
  • ????? ?? ?????? ?????? ?????? ????? / 50 ?? ????
    ???? ??????? /
  • ??? ????? ?? ?????? ????? ( ??? ??????? ???????
    ????? ?????? ?????? ???????? ??? ?????? ...)
  • ???? ????? 90 ??? ?? 20 ???? 60 ??? 20 ? 40
    ???? 10 ??? ?? 40 ???

3
Functional Anatomy
  • ????? ??????? ???? ????? ??? ????? ???? ?????
  • ?? 25 ??? ?? ????? ????? ??????? ?????? ?? ???
    ?????

4
Functional Anatomy
  • ?????? Labrum
  • ???? ?? ??? ????? ??????? ????? 50 ??? ????
    ?? ?????? ?? ??? ????? ????? 75
  • ????? ???????? ?? ????? ?????? ??? ?????
    ????? ?????? ???? ???????

5
Functional Anatomy
6
Functional Anatomy
  • ???????
  • ??? ???? ????? ??? ????? ??????? ?? ????????
  • ????? ?? ????? ???????? ?????? ?????

7
Functional Anatomy
  • ???????
  • SGHL
  • MGHL
  • IGHL ??? ?????

8
Superior Glenohumeral Ligament
  • ???? ?? ??? ?????? ?????? ??? ????? ????????
  • ?? ?????? 0 ?? ??????? ???? ?????? ??????
  • ?? ????? ???? ?????? ??????

9
Middle Glenohumeral Ligament
  • ???? ?? ?????? ???????? ?????? ??? ????????
    ?????? ??????? ?????? ??? ????? ????????
  • ????? ?? ????? ??????? ??????? ?? ??????? ??????
    ?? ???????

10
Inferior Glenohumeral Ligament Complex
  • ???? ??? ????? ?????? ??????? ???? ??? ??????
    ???????
  • ????? ??? ????? ?????? ???? ????? ????????
    ????????
  • ????? ?? ???? ?????? ????? ????? ???? ???? ????
    ???????
  • ???? ????? ?????? ???? ????? ????? ???????
    ????????

11
???? IGHL
12
Axillary Pouch
13
IGHL in abduction rotation
14
??????? ?? ??? ?????
  • ?????? ??????? ?????? ?? ??? ??? ?????
  • ?????? ???? ??????
  • Subscapularis
  • Supraspinatus
  • Infraspinatus
  • Teres minor

15
??????? ?????????????? ??????? ?? ????????
  • Passive factors
  • Active factors

16
Passive Factors
  • ????? ?????? ???? ????? ????? ?????? ???? ??? ??
    ????? ??????
  • ????? ?????? ??? ????? ??????? ???? ??????? ??
    ???? ??? ?? 1 ?? ?? ?????? (??????? ????????)
  • ???????? ?????? ?? ????? ??????? ?????? ????????
    ???? ?? ????????

17
Passive Factors
18
Passive Factors
  • ?????? ?????? ??? ????? (????? 1/3 ???? ????
    ?????) ???? ????? ??? ????? ??????? ?????
  • ???? ?????? Paccini, Ruffini ??? ??????? ????
    ????? ?? ???????? ??????? ????????

19
Active Factors
  • ????? ?????? ???? ??????? ????? ?????? ???? ????
    ????? ??? ?????
  • ??????? ???? ??? ?????? ????? ??? ????? ?? ??????
    0 ?? ???????
  • ??????? ??????? ???? ???? ????? ????? ??????? ???
    ??? ????? ?????? ?????

20
????????? ????????? ???????
21
????????? ????????? ???????
  • Bankart lesion
  • - ?? ???? ??????? ????????
  • - ???? ????? ????

22
Bankart lesion
23
????????? ????????? ???????
  • Hill-Sachs
  • - ??? ??????? ?? ??? ????? ?? ??????? ????????
    ?????? ???????? ?????
  • - ???? ?? ????? ???????
  • - ???? ????? ??? ?????? ?? ????? ??????? ???????
    ?? ???????

24
Hill-Sachs lesioninternal, external rotation,
axillary view
25
????????? ????????? ???????
  • ????? ????????? ?? ?????? ??????? ???? ??? ?????
    1/3 ????? ????? ??????? ????? ??? ???????
  • ???? ???? ?????? ??? ??? 80 ?? ????? ?????
    ?????? ??? 60 ???

26
Classification
  • The Direction
  • Unidirectional
  • Bidirectional
  • Multidirectional

27
Classification
  • Type of trauma
  • 1- Macrotraumatic???? ??? ????
  • 2- Microtraumatic (acquired)
  • ???? ????? ??????? ???? ????? plastic deformation
    ?? ??????? ??????? ????? ?????? (??? ?????????)

28
Classification
29
(No Transcript)
30
Classification
  • ????? ??????? ???? ?????? ????? ?????? ?????
  • ????? ?????? ???? ???????? ? ??????? ??????? ??
    ??? ????? ????? ???? ?? ????? ????? ? ???????
    ??????????
  • Luxatio Erecta ???? ??? ??????? ? ????? ??????
    ????? 110 160 ????
  • ????? ?????? ?????? ????? ?? ????? ??????? ????
    ?????

31
Anterior Dislocation(Subcoracoid)
32
Anterior Dislocation(Subglenoid)
33
Anterior Dislocation(Subclavicular)
34
Posterior Dislocation(Subacromial)
35
Posterior Dislocation(subspinous)
36
Inferior Dislocation(Luxatio Erecta)
37
???????
38
???????????? ???????
  • ?????? ????? ??? ?????? ??? ?????
  • ???? ????? ??? ????? ???? ??????
  • ??? ??????
  • ????? ??????? ??????? ??????? ?????
  • Generalized Hyperlaxity
  • ????? ???? ????????

39
Generalized Hyperlaxity
40
???????? ????? ???? ????????
  • Drawer test
  • ???? ??? ????? ???????? ??????? ?? ?????? 0 ??
    ???????

41
???????? ????? ???? ????????
  • Sulcus test
  • ??? ?????? ??????? 0 (????? ???? ??????) ? 45
    (????? IGHL )
  • ?? ????? 1 (??? ?? 1 ??)
  • 2 (1-2 ??)
  • 3 (???? ?? 2 ??)

42
???????? ????? ???? ????????
  • Apprehension test

43
???????? ????? ???? ????????
  • Lachman test
  • Anterior stress (1 ????,2 ??? ? ????,3 ??? ???)
  • Posterior stress

44
???????? ????? ???? ????????
  • Jerk test
  • ??? ?????? ?????

45
???????? ????? ???? ????????
  • Push Pull test
  • ??? ?????? ?????

46
???????? ????? ???? ????????
  • ?????? ??? ????? ????? ?????? (Atraumatic
    dislocation)
  • ????? ????? ?????? ???????

47
Radiographic 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

48
A-P view
49
A-P view
50
Lateral View
51
Axillary view
52
Radiographic Evaluation
  • A-P view
  • ????? ????? ?????? ??????? ??????? ????? ?? ???
    ????? ??????

53
Radiographic Evaluation
  • True A-P view
  • ?? ???? ??????? ???? ???? ???

54
Radiographic Evaluation
  • Lateral view
  • ???? ?? ????? ????? ????? ????? ?? ????

55
Radiographic Evaluation
  • Axillary view
  • ???? ?? ????? ???? ??????? ? ????? ???????

56
????????? ????
  • CT, 3D CT ?????? ???? ????? ???????? ?????? ???
    ????? ?????? ????? ?????? ?????
  • MRI ?? ??? ?? Gadolinium ?????? ??????? ???????
    ?????? ???? ??????
  • ??????? ???? ?? ????? ?????? ?????? ???? ?????
    ??? ??? ??????

57
?????? ??????? ?? ??? ???????? ????????
58
Bankart Operation
  • ????? ????? ???????
  • - ??? ??????? ? ?????? ??? ????? ?????
  • - ????? ??????? ??? ???? ????? ?? ?? ??????
  • - ????? ????? ??????

59
Bankart Operation
60
Bankart Operation
  • ?????????
  • ????? ?????? ?????? ???????? ?? ???? ?????
    ???????
  • TUBS Macro or Micro traumatic
  • ??? ?????? ?????? ????? ?????? (Microtraumatic
    Sulcus testlt2 )

61
Bankart 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)

62
Bristow Operation
  • ????? ????? ???????
  • 1- ??? ?????? ??????? ??? ????? ??????? ?????? ??
    ????? ???????
  • 2- ???? ?????? ??????? ???? ???? ????? ???? ??
    5 ??
  • ???? ?? ??????
    ?????
  • ???? ?????? ???
    ????? ??????
  • ???? ??????

63
Bristow Operation
64
Bristow Operation
  • ?????????
  • ??? ????? ??????? ???? ????? ?????
  • ???? ?????? ??????
  • ??? ??? ???????? ??? ???? ????? ??????? ???????

65
Bristow Operation
  • After Treatment
  • ???????? ???? ????? ?? ??? ?????? ??? ???? 6
    ??????
  • ???? ???????? ??? ?? 50 75 ?? ???????

66
Weber Subcapital Osteotomy
67
Capsular Shift Procedure For Multidirectional
Instability
  • Neer, OBrien Techniques

68
Neer Technique
  • ?????????
  • AMBRI ??? ?????? ?????? ??????? ?? ??? ??????
    ????? Sulcus 2,3
  • ????? ?? ????? ?? ???? ??? ???? ?????

69
Neer 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)
75
MoKazem.com
  • ??? ???????? ?? ?? ????? ??????? ?? ??????? ?
    ??????? ?? ??? ??????? ???????? ?? ???? ???????
    ??????? ?? ???? ????, ??? ????? ?. ???? ??????.
  • ?????? ??? ????? ?? ??????? ??????? ?? ???
    ????????.
  • 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
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