This masterclass, presented by Dr. Angela Cadogan and Professor Jeremy Lewis, focuses on shoulder instability, primarily traumatic instability, but also touching upon atraumatic instability. The video covers classification, pathomechanics, clinical assessment, imaging, rehabilitation, and referral criteria for orthopedic assessment.
Shoulder Instability Classification: The Stanmore classification system categorizes shoulder instability into three types: traumatic (high-force trauma), atraumatic type 2 (capsular laxity, morphological changes), and atraumatic type 3 (muscle patterning abnormalities). This system highlights the dynamic interplay between these instability types, demonstrating how one can transition into another over time.
Clinical Assessment: Accurate diagnosis relies heavily on patient history (mechanism of injury, reduction method, number of dislocations, patient goals) and physical examination (alignment, structural injury signs, neurovascular status). Specific tests, like apprehension tests, are used to assess instability, while lag signs help evaluate rotator cuff tears. Imaging (X-ray, ultrasound, MR arthrogram) is crucial for confirming structural injuries.
Pathomechanics and Pathology: Traumatic anterior instability is most common, often caused by forced abduction and external rotation. Associated pathologies include bony Bankart lesions, soft tissue Bankart lesions, Hill-Sachs lesions, and HAGL lesions. Complications like nerve injuries (auxiliary nerve) and rotator cuff tears are also discussed.
Rehabilitation: A bio-psychosocial approach is emphasized. Rehabilitation focuses on three stages: movement restoration (motor control), muscle performance, and functional restoration. The "Shape Up My Shoulder" program uses a graduated, function-based approach, incorporating chaos and cognitive challenges to promote confidence and exceed patient expectations. Virtual reality is presented as a valuable tool for rehabilitation, especially for kinesiophobic patients.
Referral Criteria: Orthopedic referral is considered for patients intending to return to high-risk activities, those with persistent symptoms (positive apprehension test after 6 weeks, unresolved auxiliary nerve issues), and those with significant structural pathology revealed through imaging.
