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Chapter 13: The Shoulder and Upper Arm

This chapter delves into the passive and dynamic stabilizers of the glenohumeral (GH) joint, addressing various forms of instability including anterior, posterior, and multidirectional. It highlights injury mechanisms, pain characteristics, and diagnostic tests such as the Apprehension and Relocation tests, as well as descriptions of significant conditions like Bankart and Hill-Sachs lesions. Furthermore, it explores the Sulcus Sign for identifying inferior GH laxity, differentiating it from the AC Traction Test, offering comprehensive insights into GH joint complexities.

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Chapter 13: The Shoulder and Upper Arm

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  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 900 abduction • Posterior instability • Repetitive microtrauma • Longitudinal force on humerus, internal rotation, GH flexion 900, horizontal adduction • Multidirectional instability • Typically External rotation and 900 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

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