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 90 0 abduction  Posterior instability  Repetitive microtrauma  Longitudinal force on humerus, internal rotation, GH flexion 90 0, horizontal adduction  Multidirectional instability  Typically External rotation and 90 0 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