1 / 24

Bracing Options for Shoulder Instability

James Penna,MD. Bracing Options for Shoulder Instability. Case Study.

marlie
Download Presentation

Bracing Options for Shoulder Instability

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. James Penna,MD Bracing OptionsforShoulder Instability

  2. Case Study • Pat St. Jock sustains a shoulder dislocation during the first drill of the first practice of the season. The Athletic Trainer manages to reduce the shoulder before the ambulance arrives which greatly alleviates symptoms. The ER work-up is negative for fracture, they advise follow-up with Ortho in a couple of days. • 8am the following morning Pat is sitting in your office looking for advice on how to proceed.

  3. What do we know? • 1st time dislocator • No fractures • Pat wants to play

  4. Decision Support • Sport/Desired activity • Dominant Arm in Overhand athlete • Marine? • Physical Exam • !!!!Deltoid Function!!!! • X-rays • Are they enough?

  5. MRI • Labral Tear • Bankart called it the ‘essential’ lesion • Cuff Tear • Glenoid Fracture • Bony Bankart • Humeral Head Fracture • Other?

  6. That’s not Pat • “Changes on axial sequences suggestive of labral tearing. Recommend MR arthrogram for more definitive visualization.”

  7. This is reality (Hypothetically) • Treat the patient • Immobilize • Rehabilitate • Return to activity • ?Brace

  8. Immobilize

  9. Immobilize

  10. Immobilize

  11. Which one? How Long? • No one has been able to reproduce the Japanese results. • ER is probably slightly better than traditional • But both stink • 40% recurrence for all comers • Much higher in college population • 1 week no different than 3 or 6

  12. Personally • 2wks with pillow or moderate ER • Regular sling for Negative MRI • Strengthening program • Functional brace

  13. Functional Bracing

  14. Sully

  15. Duke-Wyre

  16. Sawa

  17. Generic Neoprene

  18. Other?

  19. Evidence based • Limited • Just like the knee there seems to be a benefit to tactile contact • Improved Proprioception/Kinesthetic Sense • Improved Confidence

  20. Well Why the Heck Not? • Recurrent instability can create trouble

More Related