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Shoulder Labral Tear Algorithm

Shoulder Labral Tear Algorithm

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Shoulder Labral Tear Algorithm

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  1. Shoulder Labral Tear Algorithm Rick Hill, Sarah Jarvis Mallory Mahoney, Madeline McCann Lauren Mulsow

  2. Anatomy/ Biomechanics • Glenohumeral joint • Ball and Socket Joint • Labrum • Deepens glenoid • Increases Stability https://www.google.com/search?q=glenoid+labrum&client=firefox-a&hs=iTb&rls=org.mozilla:en-US:official&source=lnms&tbm=isch&sa=X&ei=xiV1UauAGafP2QWIn4H4CQ&ved=0CAoQ_AUoAQ&biw=1525&bih=619#imgrc=yI7VaEG1zjuTaM%3A%3B1f0zuB-p1xsv9M%3Bhttp%253A%252F%252Fdc169.4shared.com%252Fimg%252FzwFqk3fW%252Fpreview_html_4359dc90.png%3Bhttp%253A%252F%252Fdc169.4shared.com%252Fimg%252FzwFqk3fW%252Fpreview.html%3B312%3B292

  3. Injury • SLAP lesion • Superior labral • Anterior to Posterior • Bankart lesion • Inferior labral http://www.myerssportsmedicine.com/art/slap-lesion-bankart-tear.gif

  4. Mechanism of Injury • Macro Trauma • Fall on Out Stretched Hand • Direct blow • Sudden pull • Micro Trauma • Repetitive overuse injury

  5. Differential Diagnosis • Glenohumeral instability • Rotator Cuff Pathology • Shoulder impingement

  6. Risk Factors • Participation in Sports • Micro-trauma secondary to shear force directed at the glenoid and labrum • Trauma • Force translating the humeral head relative to the glenoid • Anterior / Posterior Shoulder Instability • Increased risk secondary to increased translation of humeral head • Glenoid Dysplasia • A bone deficiency of the posteroinferiorglenoid rim and hypertrophy of surrounding cartilage can increase risk of tear from shear forces

  7. Symptoms • Catching, clicking, locking, popping, grinding • Decreased ROM • Loss of strength • Ache • Pain with overhead activities • Pain with axial loading • Feeling of instability (dislocation/subluxation)

  8. History: • Young OH athlete (throwing injury) • compressive or distraction force on the shoulder • fall onto outstretched hand or elbow w/GH jt adducted and extended “traumatic injury that involves substantial forces on the GH joint” • Symptoms: • catching, clicking, popping , locking, grinding • deep shoulder pain • pain w/OH activity • pain w/axial loading • sense of instability • decreased ROM • decreased MMT Instability (rule out) - Apprehension Test - Apprehension/Relocation Test • Impingement (rule out) • Hawkins-Kennedy • Neer • Horizontal Adduction • Yocum • RTC (rule out) • Empty can • Drop sign • Painful arc • ER Lag sign • Labral (rule in): • Biceps Load Test I • Biceps Load Test II • Internal Rotation Resistance Test • Kim test • Jerk test

  9. Take Home Message • When examining a patient with suspected labral tear it is important to understand the anatomy and biomechanics of the shoulder as well as associated risk factors and mechanisms of injury. • Knowledge of this information, in combination with the patient profile will help to determine the direction to take upon objective exam of the patient. • This algorithm can be used to test applicable hypotheses after the subjective exam and will help to guide a thorough yet efficient objective exam.

  10. References • Cleland, J.A., Koppenhaver, S. (2011). Netter’s Orthopaedic Clinical Examination: An Evidence-Based Approach. 2nd Ed. Philadelphia: Saunders – Elsevier. • Dutton, M. (2004). The Shoulder Complex. Orthopaedic: Examination, evaluation, & intervention. (pp. 476). New York, NY:McGraw-Hill. • Dutton, M. (2008). The Shoulder Complex. Orthopaedic examination, evaluation, and intervention (2nd ed., pp. 405-519). New York: McGraw-Hill Medical. • Escobedo, E.M., Richardson, M.L., & Schulz, Y.B.E. (2007). Increased Risk of Posterior Glenoid Labrum Tears in Football Players. American Journal of Roentgenology, 188 (1), 193-197.  • Guanche, C.A., Jones, D.C. (2003) “Clinical Testing for Tears of the Glenoid Labrum.” Arthroscopy: The Journal of Arthroscopic and Related Surgery, 19 (5), 517-523. • Harper, K. W., Helms, C. A., Haystead, C. M., Higgins, L. D. (2005). Glenoid Dysplasia: Incidence and Association with Posterior Labral Tears as Evaluated on MRI. American Journal of Roentgenology, 184 (3), 984-988.   • Luime, J.W., Verhangen, A.P., Miedema, H.S., Kuiper, J.I., Burdorf, A., Verhaar, J.A.N., Koes, B.W. (2004) “Does This Patient Have an Instability of the Shoulder or a Labrum Lesion?” Journal of the American Medical Association,292 (16), 1989-1999. • Munro, Wendy, and Raymond Healy. "The Validity and Accuracy of Clinical Tests Used to Detect Labral Pathology of the Shoulder – A Systematic Review." Manual Therapy14.2 (2009): 119-30. ScienceDirect. Web. 21 Apr. 2013.  • Nam, E. K., & Snyder, S. J. (2003). Clinical Sports Medicine Update. The Diagnosis and Treatment of Superior Labrum, Anterior and Posterior (SLAP) Lesions. The American Journal of Sports Medicine, 31(5), 798-810. Retrieved April 17, 2013, from the PubMed database. • NYU Langone Medical Center. (n.d.). NYU Langone Medical Center. Retrieved April 17, 2013, from http://www.med.nyu.edu/content?ChunkIID=432320#risk