Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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SINGLE MONOGRAPH SALE
25.3.1, Shoulder Instability:
A Review of Anatomical and Biomechanical Considerations,
Prevalence, and Diagnosis as well as Nonoperative and Operative Management

Abstract:


CONTENT: The literature for shoulder instability is reviewed. Shoulder function is related to impairments and disabilities that occur when stability is lost. The authors formally define instability and distinguish this condition from joint laxity. The anatomy and biomechanics associated with shoulder stability and pathomechanics underlying types of instability are covered in detail. Traumatic and atraumatic etiologies are distinguished. Common classifications of shoulder instability are reviewed. A major section focuses on examination using appropriate clinical measures to distinguish normal and abnormal findings. A detailed section on rehabilitation is divided into nonoperative and operative management. Nonoperative management of shoulder instability and the implementation of an evidence-based rehabilitation program are addressed. Operative management and common surgical techniques, possible complications, postoperative precautions, and rehabilitation goals for primary types of shoulder instability are reviewed. Recommendations for safe return of postsurgical and nonsurgical patients to their prior level of function, occupation, and sport for varied types of shoulder instability are highlighted. Currently used outcome measures for shoulder instability are reviewed. CASE ANALYSES: Two case studies are presented. The first case involves the nonoperative management of a 12-year-old female swimmer who complains of gradual onset of bilateral shoulder pain with swimming. The second case involves operative management for a 21-year-old Division I hockey player who sustained an acute dislocation while playing. Both cases address evaluation, treatment and outcomes.

Authors:


Brittany Lynch, PT, DPT; Tara Ridge, MS, PT, SCS; Dharmesh Vyas, MD, PhD

Learning Objectives:

Upon completion of this monograph, the course participant will be able to:

  1. Define glenohumeral instability and laxity and describe incidence, prevalence, pathomechanics, and mechanism of injury for each.
  2. Recognize the prevalence of shoulder instability and identified risk factors.
  3. Describe the active and passive restraints about the shoulder, including their anatomical differences, the key roles in providing stability, and the relationship to glenohumeral instability.
  4. Differentiate between anterior, posterior, and multidirectional instability and describe patient reported symptoms as well as typical injury patterns for each direction of shoulder instability.
  5. Discuss the difference in the pathomechanics and management of traumatic and atraumatic shoulder instability.
  6. Recognize and describe classification systems for shoulder instability.
  7. Describe possible concomitant and secondary injuries associated with shoulder instability.
  8. Determine and perform an examination using appropriate tests and measures to accurately assess shoulder instability and the associated impairments and functional limitations.
  9. Determine the appropriate use of diagnostic testing, as well as recognize and describe the difference between normal and abnormal findings.
  10. Describe the patient population that is most appropriate for nonoperative management of shoulder instability and implement an evidence-based rehabilitation program.
  11. Identify the criteria for operative management and demonstrate an understanding of the surgical techniques, possible complications, postoperative precautions, and rehabilitation goals for all types of shoulder instability discussed in this monograph.
  12. Describe the recommendations and differences for returning a patient, surgical and nonsurgical, to prior level of function, occupation, and sport for all types of shoulder instability discussed in this monograph.
  13. Describe, use, and interpret appropriate outcome measures for shoulder instability.
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