1. The Shoulder Part II
Age < 40

2. Instability Traumatic Atraumatic ‘it ain’t out unless it’s out’
Xray proof needed
Atraumatic

3. Shoulder Dislocation

4. Symptoms Pain in the front of the shoulder
Pain with shoulder in position of instability (abduction and external rotation)
Apprehension test

5. Apprehension Test
Start with abduction, no rotation. Gently add External Rotation

6. Traumatic Instability
>98% are anterior (dislocated with arm in some combination of abduction/external rotation)
Neurovascular injury is rare
Initial tx: shoulder immobilizer (4weeks), refer to Ortho and PT
Beware patients > 50 yo (RCT is common)
Surgery if recurrent

7. Where does ‘velocity’ come from

8. Atraumatic Instability
Repetitive microtrauma in a position of instability (ABD/ER): swimmers, throwers, weight lifters. “Secondary impingement”
Anterior capsule is slowly being stretched.
Tx: PT to strengthen anterior rotator cuff (subscapularis) for “muscle repair” and restrict offending activities

9. Shoulder Injury Can be major pain after minor injury
Pain limits active shoulder motion, not rotator cuff “tear”
Exclude a fracture: AP/lateral radiographs

10. Shoulder Injury, normal xray
Tender deltoid muscle= contusion
Neuro symptoms= traction to brachial plexus
Test rotator cuff to prove it works (just need to feel tension)
Treatment: Sling, ice, analgesic, PT in 2-3 weeks