OCS Study Shoulder

4mm

0.5-3mm

Posterior capsular ligament

• Elevation - 45
• Depression - 10
• Protraction - 30
• Retraction - 30
• Rotation - 15-40

Below 90-10 deg

Superior & inferior capsular lig

Clavicular elevation, protraction, superior and anterior displacement.

Compression, and is also a secondary restrain to elevation and protraction.

• 1. Scaption with thumb up
• 2. Press down
• 3. Push-up with pluss
• 4. Retraction

• 1. Scaption with thumb up
• 2. Press down
• 3. Flexion with thmb up (to 90deg)
• 4. Prone ER with horizontal extension (prone horizontal abd with ER)

• Normal = 66%
• Posterior dominant shoulder = 76%

• Lateral pain
• Pain with overhead lifting/painful arc
• Pain at night
• Compensatory shrug
• >40 yo

• Macrotrauma
• Functional disability
• Pain: lateral; dull, constant ache; night; awakens
• Compensatory shrug
• >40 yo

• Anti-inflam techniques (ice, phono, HVE, NSAIDs, ionto)
• Joint mobiliztions: posterior and inferior as capsular tightness dictates
• Dynamic stabilization drills

• Use healing treatments (MHP, cont US, transverse friction)
• Exerisse: eccentrics, dynamic stabilization
• Joint mobs: posterior and inferior as capsulra tightness dictates

• Healing treatments (MHP, Cont US, transverse friction massage)
• Exercise: eccentrics, dynamic stabilization

• usually single-row fixation which leads to reduced fixation strength
• Less pain & stiffness
• Rehab more cautiosly

• Double-row fixation - usually stronger
• More pain

• Evolving
• May allow for more progressive rehab

Early repairs have greater stiffness post op - progressed more quickly

have less inflammation - progressed more conservatively

• Tenderness over intertubercular sulcus - most common symptom
• Pain moves laterally with ER
• Pain will radiate into muscle belly
• MOI: eccentric deceleration activities

• Inflammation
• Instability
• Rupture

• Better cosmesis
• Better supinator strength (8% deficit)
• Longer recovery
• Used in active patients <55 yo

• Preferred method
• Faster return to work
• Equivalent elbow flexion strength
• Supinator strength deficit (21%)

• - fraying and degeneration of the superior labrum, normal biceps (no detachment);
• - most common type of SLAP tear (75% of SLAP tears);
• - often associated with rotator cuff tears;
• - these are treated w/ debridement;

• detachment of superior labrum and biceps insertion from the supra-glenoid tuberlce;
• - when traction is applied to the biceps, the labrum arches away from the glenoid;
• - typically the superior and middle glenohumeral ligaments are unstable;
• - may resemble a normal variant (Buford complex);
• - 3 subtypes: based on detachment of labrum involved anterior aspect of labrum alone, the posterior aspect alone, or both aspects;
• - posterior labram tears may be caused by
• impingement of cuff against the labrum with the arm in the abducted and
• externally rotated position;
• - as noted by Tae Kyun Kim et al. type-II lesions in patients older than 40 years of age were associated with a supraspinatus tear where as
• in patients younger than 40 years were associated
• with participation in overhead sports and a Bankart lesion;
• - treatment involves anatomic arthroscopic repair;

• - bucket handle type tear;
• - biceps anchor is intact;

• - vertical tear (bucket-handle tear) of the superior labrum, which extends into biceps (intrasubstance tear);
• - may be treated w/ biceps tenodesis if more than 50% of the tendon is involved;

Type I and III

Type II and IV

• Vague deep joint pain
• History of macrotrauma: force that pushes the humeral head over or away from the superio rlabrum
• History of deceleration activites/overhead cocking position
• Complaint of locking, popping, catching

Gadolinium MRI because dy extravasates into labrum tears.

• Insidious, rogressive, global loss of AROM & PROM
• Affects joint capsule and GH ligs (not muscle or fascia)

• Acquired (post surgical, post traumatic)
• Afects joint, capsulre, GH ligs and extra-articular tissues and fascia

ER, Abduction, IR

• Sulcus sign at 0 deg (superior capsule/ligs)
• Sulcus sign at 90 deg (inferior capsule/ligs)
• Anterior load and shift
• Posterior lad and shift

• 0-3 months
• Progressive pain
• Global loss of AROM & PROM due to pain
• Arthroscopy reveals hypertrophic vascular synovitis

• 3-9 months
• Persistent pain
• Progressive loss of ROM (due to pain & reduced capsular volume)
• Arthroscopy reveals dense hypervascular synovitis, perivascular scar formation, capsular fibroplasia, disorganized collagen fibrils, NO inflammatory infilitrates

• 9-14 months
• Reduced pain
• Significant global ROM limitations (due to capsular fibrosis and decreased capsular volume)
• Arthroscopy reveals unremarkable, patches of synovial thickening, no evidence of hypervascularity, presence of dense hypercellular collagenous tissue.

• Greater than 14 months
• Similar to stage III

Avoid aggressive ROM and joint mogs as these can potentially accelerate disease process and not needed as histologic changes have not occured.

Stage I and II