SlideShare a Scribd company logo

Posterior instability of the shoulder lennard funk

•
•
Lennard Funk
Lennard Funk

Posterior instability of the shoulder - understanding the pathomechanics, clinical assessment and treatment

Education
1 of 39
Download to read offline
Lennard Funk @theshoulderdoc
PLAN Posterior instability:! Pathomechanics! Diagnosis! Management ! Results
HISTORY 20th Century! Plethora of surgical techniques ! Poor results (Hawkins, 1984)! Poor understanding
POSTERIOR RESTRAINTS 1. Capsule! 2. Labrum – Posterior Bankart! 3. Glenoid Shape
POSTERIOR LABRUM
POSTERIOR CAPSULE Thin RHAGL! Mid-capsule
KIM LESION Seung-Ho Kim. Arthroscopy. 2004
REDUCED EXTERNAL ROTATION
GLENOID Version! Deficiencies Semogas, Granville-Chapman & Funk, 2014
GLENOID WEAR
POSTERIOR INSTABILITY 1. Traumatic 2. Atraumatic
ATRAUMATIC Capsular Laxity +/- Muscle Patterning Disorder
TRAUMATIC Contact sports! May be minor! Convulsion
RUGBY SHOULDER INJURIES Malone, Funk, Mohammed, Ball. Shoulder injury patterns in Rugby - the Collision Shoulder. JBJS (Suppl). 2008. ABER Tackle Direct Impact Neurological Lesion 32% 15% Soft tissue Bankart 79% 33% Bony Bankart 26% 11% Posterior Labral Tear 11% 50% SLAP 7% 35% Partial Cuff Tear 32% 12%
Specificity Sensitivity Notes Reference Posterior Drawer Test No data Load & Shift 100% 14% For Laxity Gerber & TRADITIONAL TESTS Ganz. JBJSB. 1984 Posterior Apprehension 99% 20% Jia et al. JBJSA. 2009 Jerk Test 85% 90% posteroinf. labral tear Kim et al. AJSM. 2004 Kim Test 95% 80% posteroinf. labral tear Kim et al. CORR. 1993
MODIFIED O’BRIEN’S TEST (MOB)! WRIGHTINGTON POSTERIOR INSTABILITY TEST (WPIT) • Conducted in a similar manner to that initially described by O’Brien • Patient asked to forward flex the affected arm 90° with the elbow in full extension. • Adduct the arm fully, medial to the sagittal plane of the body. • Internally rotate so that the thumb points downward. • The examiner then applies a downward force to the arm being resisted by the patient. • The test is considered positive with objective weakness observed by the examiner when downward force on the arm resulted in loss of forward flexion from 90°. Owen, Mackenzie, Boulter, Funk, 2014
MODIFIED O’BRIEN’S TEST (MOB)! WRIGHTINGTON POSTERIOR INSTABILITY TEST (WPIT) Owen, Mackenzie, Boulter, Funk, 2014
Specificity Sensitivity Notes Reference Posterior Drawer Test No data Load & Shift 100% 14% For Laxity Gerber & Ganz. JBJSB. 1984 Posterior Apprehension 99% 20% Jia et al. JBJSA. 2009 Jerk Test 85% 90% posteroinf. labral tear Kim et al. AJSM. 2004 Kim Test 95% 80% posteroinf. labral tear Kim et al. CORR. 1993 MOB/WPIT 25% 83% Muscular Athletes Owen et al. IJSS. 2014 POSTERIOR INSTABILITY TESTS
MR ARTHROGRAM
GOLFER’S SHOULDER
MUSCLE EFFECTS
JOINT CAPSULE
EXCESS INTERNAL ROTATION
POSTERIOR STABILISATION Arthroscopic superseding Open >85% Success at 2 years ! Lower Morbidity! Easier Revision! Treat Associated Pathology:! Reverse HS; SLAP; Anterior Labrum; Rotator Cuff
OPEN SURGERY Glenoid bone loss > 25%! Failed Revision soft tissue repairs! Massive Reverse Hill-Sachs Lesion! (Reverse HAGL)
EXAMINATION UNDER ANAESTHESIA
BEACH CHAIR POSITION
PORTALS
POSTERIOR GLENOID BONE LOSS
POST-OP
POST-OP Phase 1: (Level 1 Exercises) Core stability & Scapula control! Proprioceptive exercises (minimal weightbearing below 90 degrees)! Active assisted ROM as comfortable (in 'safe zone' )! Do not force or stretch No combined adduction & internal rotation Phase 2: (Level 2 Exercises) Progress active assisted to active ROM as comfortable! Phase 3: (Level 3+ Exercises) Regain scapula & glenohumeral stability working for shoulder joint control rather than range! Gradually Strengthen! Sports-specific rehabilitation - Plyometrics and pertubation training
RESULTS Badge, Tambe, Funk. Arthroscopic isolated posterior labral repair in rugby players. Int J Should Surg. 2009. 143 shoulders; 32m FU Return to Play = 4.3m! Recurrent Instability = 6/143 (5%) Pre-Op Post-Op Constant Score 65 99 Oxford Score 33 18 Oxford Instability Score 52 13
SUMMARY Posterior instability:! Types! Mechanisms! Management ! Results
THANK YOU lenfunk@shoulderdoc.co.uk @theshoulderdoc
@THESHOULDERDOC Full Time / Part Time LENFUNK@SHOULDERDOC.CO.UK

Recommended

Shoulder instability current concepts mike walton
Shoulder instability current concepts mike waltonShoulder instability current concepts mike walton
Shoulder instability current concepts mike waltonLennard Funk
 
Post instability echte
Post instability echtePost instability echte
Post instability echteTheRightDoctors
 
Shoulder instability
Shoulder instabilityShoulder instability
Shoulder instabilityAnup Maurya
 
Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado
Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail ColoradoRecurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado
Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail ColoradoPeter Millett MD
 
Multidirectional instability of the shoulder 2014
Multidirectional instability of the shoulder 2014Multidirectional instability of the shoulder 2014
Multidirectional instability of the shoulder 2014Lennard Funk
 
Assessment of the unstable shoulder
Assessment of the unstable shoulderAssessment of the unstable shoulder
Assessment of the unstable shoulderWrightington Upper Limb Unit
 
The athletes shoulder 2014 len funk
The athletes shoulder 2014 len funkThe athletes shoulder 2014 len funk
The athletes shoulder 2014 len funkLennard Funk
 
Posterior instability Test - Lennard Funk
Posterior instability Test - Lennard FunkPosterior instability Test - Lennard Funk
Posterior instability Test - Lennard FunkLennard Funk
 

Recommended

Shoulder instability current concepts mike walton
Shoulder instability current concepts mike waltonShoulder instability current concepts mike walton
Shoulder instability current concepts mike waltonLennard Funk
 
Post instability echte
Post instability echtePost instability echte
Post instability echteTheRightDoctors
 
Shoulder instability
Shoulder instabilityShoulder instability
Shoulder instabilityAnup Maurya
 
Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado
Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail ColoradoRecurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail Colorado
Recurrent Posterior Shoulder Instability | Orthopaedic Surgeon | Vail ColoradoPeter Millett MD
 
Multidirectional instability of the shoulder 2014
Multidirectional instability of the shoulder 2014Multidirectional instability of the shoulder 2014
Multidirectional instability of the shoulder 2014Lennard Funk
 
Assessment of the unstable shoulder
Assessment of the unstable shoulderAssessment of the unstable shoulder
Assessment of the unstable shoulderWrightington Upper Limb Unit
 
The athletes shoulder 2014 len funk
The athletes shoulder 2014 len funkThe athletes shoulder 2014 len funk
The athletes shoulder 2014 len funkLennard Funk
 
Posterior instability Test - Lennard Funk
Posterior instability Test - Lennard FunkPosterior instability Test - Lennard Funk
Posterior instability Test - Lennard FunkLennard Funk
 
The HAGL lesion
The HAGL lesionThe HAGL lesion
The HAGL lesionHiren Divecha
 
Adv Rehab Draft 11.11.15
Adv Rehab Draft 11.11.15Adv Rehab Draft 11.11.15
Adv Rehab Draft 11.11.15Laura Wind
 
Atraumatic Shoulder Instability
Atraumatic Shoulder InstabilityAtraumatic Shoulder Instability
Atraumatic Shoulder InstabilityThe Arm Clinic
 
Shoulder instability
Shoulder instabilityShoulder instability
Shoulder instabilityMandeep Singh Brar
 
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Lennard Funk
 
Slap Tears
Slap TearsSlap Tears
Slap TearsRebecca Zahniser
 
Anterior Glenohumeral Instability
Anterior Glenohumeral InstabilityAnterior Glenohumeral Instability
Anterior Glenohumeral InstabilityChristian Veillette
 
Shoulder Sjsu Rehab
Shoulder Sjsu RehabShoulder Sjsu Rehab
Shoulder Sjsu RehabRoss Nakaji
 
Multidirectional shoulder instability
Multidirectional shoulder instabilityMultidirectional shoulder instability
Multidirectional shoulder instabilityShoulder Library
 
Shoulder instabilty
Shoulder instabiltyShoulder instabilty
Shoulder instabiltyDr.A.Mohan krishna
 
Reverse arthroplasty rehab rachael daw nwulg new
Reverse arthroplasty rehab rachael daw nwulg newReverse arthroplasty rehab rachael daw nwulg new
Reverse arthroplasty rehab rachael daw nwulg newLennard Funk
 
Jose Austine- Shoulder instability
Jose Austine- Shoulder instability Jose Austine- Shoulder instability
Jose Austine- Shoulder instability Jose Austine
 
Arthroscopic Stablization Cherry Blossom Final 2009
Arthroscopic Stablization Cherry Blossom Final 2009Arthroscopic Stablization Cherry Blossom Final 2009
Arthroscopic Stablization Cherry Blossom Final 2009haydenmac
 
Arthroscopic bankart’s repair
Arthroscopic bankart’s repairArthroscopic bankart’s repair
Arthroscopic bankart’s repairorthoprince
 
Surgery for shoulder instability len funk
Surgery for shoulder instability len funkSurgery for shoulder instability len funk
Surgery for shoulder instability len funkLennard Funk
 
Reverse Total Shoulder Arthroplasty Research Presentation
Reverse Total Shoulder Arthroplasty Research PresentationReverse Total Shoulder Arthroplasty Research Presentation
Reverse Total Shoulder Arthroplasty Research Presentationtylers56
 
Non union neck of femur
Non union neck of femurNon union neck of femur
Non union neck of femurJose Austine
 
Current concepts in the management of shoulder instability
Current concepts in the management of shoulder instabilityCurrent concepts in the management of shoulder instability
Current concepts in the management of shoulder instabilityPonnilavan Ponz
 
Shoulder Impingement : The Surgeon's Approach
Shoulder Impingement : The Surgeon's ApproachShoulder Impingement : The Surgeon's Approach
Shoulder Impingement : The Surgeon's ApproachThe Arm Clinic
 
Shoulder instability- anatomy mechanism & treatment
Shoulder instability- anatomy mechanism & treatmentShoulder instability- anatomy mechanism & treatment
Shoulder instability- anatomy mechanism & treatmentdocortho Patel
 
Shoulder instability (anatomy,types, management )
Shoulder instability (anatomy,types, management )Shoulder instability (anatomy,types, management )
Shoulder instability (anatomy,types, management )DrHarpreet Bhatia
 
Shoulder labral tears MRI
Shoulder labral tears MRIShoulder labral tears MRI
Shoulder labral tears MRIDr. Mohit Goel
 

More Related Content

What's hot

Adv Rehab Draft 11.11.15
Adv Rehab Draft 11.11.15Adv Rehab Draft 11.11.15
Adv Rehab Draft 11.11.15Laura Wind
 
Atraumatic Shoulder Instability
Atraumatic Shoulder InstabilityAtraumatic Shoulder Instability
Atraumatic Shoulder InstabilityThe Arm Clinic
 
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Lennard Funk
 
Anterior Glenohumeral Instability
Anterior Glenohumeral InstabilityAnterior Glenohumeral Instability
Anterior Glenohumeral InstabilityChristian Veillette
 
Shoulder Sjsu Rehab
Shoulder Sjsu RehabShoulder Sjsu Rehab
Shoulder Sjsu RehabRoss Nakaji
 
Multidirectional shoulder instability
Multidirectional shoulder instabilityMultidirectional shoulder instability
Multidirectional shoulder instabilityShoulder Library
 
Reverse arthroplasty rehab rachael daw nwulg new
Reverse arthroplasty rehab rachael daw nwulg newReverse arthroplasty rehab rachael daw nwulg new
Reverse arthroplasty rehab rachael daw nwulg newLennard Funk
 
Jose Austine- Shoulder instability
Jose Austine- Shoulder instability Jose Austine- Shoulder instability
Jose Austine- Shoulder instability Jose Austine
 
Arthroscopic Stablization Cherry Blossom Final 2009
Arthroscopic Stablization Cherry Blossom Final 2009Arthroscopic Stablization Cherry Blossom Final 2009
Arthroscopic Stablization Cherry Blossom Final 2009haydenmac
 
Arthroscopic bankart’s repair
Arthroscopic bankart’s repairArthroscopic bankart’s repair
Arthroscopic bankart’s repairorthoprince
 
Surgery for shoulder instability len funk
Surgery for shoulder instability len funkSurgery for shoulder instability len funk
Surgery for shoulder instability len funkLennard Funk
 
Reverse Total Shoulder Arthroplasty Research Presentation
Reverse Total Shoulder Arthroplasty Research PresentationReverse Total Shoulder Arthroplasty Research Presentation
Reverse Total Shoulder Arthroplasty Research Presentationtylers56
 
Non union neck of femur
Non union neck of femurNon union neck of femur
Non union neck of femurJose Austine
 
Current concepts in the management of shoulder instability
Current concepts in the management of shoulder instabilityCurrent concepts in the management of shoulder instability
Current concepts in the management of shoulder instabilityPonnilavan Ponz
 
Shoulder Impingement : The Surgeon's Approach
Shoulder Impingement : The Surgeon's ApproachShoulder Impingement : The Surgeon's Approach
Shoulder Impingement : The Surgeon's ApproachThe Arm Clinic
 
Shoulder instability- anatomy mechanism & treatment
Shoulder instability- anatomy mechanism & treatmentShoulder instability- anatomy mechanism & treatment
Shoulder instability- anatomy mechanism & treatmentdocortho Patel
 

What's hot (20)

The HAGL lesion
The HAGL lesionThe HAGL lesion
The HAGL lesion
 
Adv Rehab Draft 11.11.15
Adv Rehab Draft 11.11.15Adv Rehab Draft 11.11.15
Adv Rehab Draft 11.11.15
 
Atraumatic Shoulder Instability
Atraumatic Shoulder InstabilityAtraumatic Shoulder Instability
Atraumatic Shoulder Instability
 
Shoulder instability
Shoulder instabilityShoulder instability
Shoulder instability
 
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
Rehabilitation following a reversed total shoulder arthroplasty nwulg 28.2.12
 
Slap Tears
Slap TearsSlap Tears
Slap Tears
 
Anterior Glenohumeral Instability
Anterior Glenohumeral InstabilityAnterior Glenohumeral Instability
Anterior Glenohumeral Instability
 
Shoulder Sjsu Rehab
Shoulder Sjsu RehabShoulder Sjsu Rehab
Shoulder Sjsu Rehab
 
Multidirectional shoulder instability
Multidirectional shoulder instabilityMultidirectional shoulder instability
Multidirectional shoulder instability
 
Shoulder instabilty
Shoulder instabiltyShoulder instabilty
Shoulder instabilty
 
Reverse arthroplasty rehab rachael daw nwulg new
Reverse arthroplasty rehab rachael daw nwulg newReverse arthroplasty rehab rachael daw nwulg new
Reverse arthroplasty rehab rachael daw nwulg new
 
Jose Austine- Shoulder instability
Jose Austine- Shoulder instability Jose Austine- Shoulder instability
Jose Austine- Shoulder instability
 
Arthroscopic Stablization Cherry Blossom Final 2009
Arthroscopic Stablization Cherry Blossom Final 2009Arthroscopic Stablization Cherry Blossom Final 2009
Arthroscopic Stablization Cherry Blossom Final 2009
 
Arthroscopic bankart’s repair
Arthroscopic bankart’s repairArthroscopic bankart’s repair
Arthroscopic bankart’s repair
 
Surgery for shoulder instability len funk
Surgery for shoulder instability len funkSurgery for shoulder instability len funk
Surgery for shoulder instability len funk
 
Reverse Total Shoulder Arthroplasty Research Presentation
Reverse Total Shoulder Arthroplasty Research PresentationReverse Total Shoulder Arthroplasty Research Presentation
Reverse Total Shoulder Arthroplasty Research Presentation
 
Non union neck of femur
Non union neck of femurNon union neck of femur
Non union neck of femur
 
Current concepts in the management of shoulder instability
Current concepts in the management of shoulder instabilityCurrent concepts in the management of shoulder instability
Current concepts in the management of shoulder instability
 
Shoulder Impingement : The Surgeon's Approach
Shoulder Impingement : The Surgeon's ApproachShoulder Impingement : The Surgeon's Approach
Shoulder Impingement : The Surgeon's Approach
 
Shoulder instability- anatomy mechanism & treatment
Shoulder instability- anatomy mechanism & treatmentShoulder instability- anatomy mechanism & treatment
Shoulder instability- anatomy mechanism & treatment
 

Viewers also liked

Shoulder instability (anatomy,types, management )
Shoulder instability (anatomy,types, management )Shoulder instability (anatomy,types, management )
Shoulder instability (anatomy,types, management )DrHarpreet Bhatia
 
Shoulder labral tears MRI
Shoulder labral tears MRIShoulder labral tears MRI
Shoulder labral tears MRIDr. Mohit Goel
 
Shoulder clinical tests validity eleanor richardson
Shoulder clinical tests validity eleanor richardsonShoulder clinical tests validity eleanor richardson
Shoulder clinical tests validity eleanor richardsonLennard Funk
 
Massive rotator cuff tears - decision making 2015
Massive rotator cuff tears - decision making 2015Massive rotator cuff tears - decision making 2015
Massive rotator cuff tears - decision making 2015Lennard Funk
 
John Orchard - hamstrings injuries
John Orchard - hamstrings injuriesJohn Orchard - hamstrings injuries
John Orchard - hamstrings injuriesMuscleTech Network
 
Seminar on applied anatomy and surgical approaches to shoulder
Seminar on applied anatomy and surgical approaches to shoulderSeminar on applied anatomy and surgical approaches to shoulder
Seminar on applied anatomy and surgical approaches to shoulderDr.Hari krishna Bachu
 
Full thickness rotator cuff tears, Value of clinical tests
Full thickness rotator cuff tears, Value of clinical testsFull thickness rotator cuff tears, Value of clinical tests
Full thickness rotator cuff tears, Value of clinical testsHanneke van der Weijden
 
The Cholesterol Conundrum: Final Cut
The Cholesterol Conundrum: Final CutThe Cholesterol Conundrum: Final Cut
The Cholesterol Conundrum: Final CutIvor Cummins
 
Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.MuscleTech Network
 
Slideshow: Shoulder Region Posterior
Slideshow: Shoulder Region PosteriorSlideshow: Shoulder Region Posterior
Slideshow: Shoulder Region PosteriorThe Funky Professor
 
The effectiveness of manipulations to the thoracic spine on functional outcom...
The effectiveness of manipulations to the thoracic spine on functional outcom...The effectiveness of manipulations to the thoracic spine on functional outcom...
The effectiveness of manipulations to the thoracic spine on functional outcom...jmrobiso
 
Clinical Examination Of Shoulder
Clinical Examination Of Shoulder Clinical Examination Of Shoulder
Clinical Examination Of Shoulder Maley Deepak kumar
 
Shoulder instability
Shoulder instability Shoulder instability
Shoulder instability Reenu Purohit
 
SCJ instability athletes 2017
SCJ instability athletes 2017SCJ instability athletes 2017
SCJ instability athletes 2017Lennard Funk
 
Understanding shoulder instability
Understanding shoulder instabilityUnderstanding shoulder instability
Understanding shoulder instabilityLennard Funk
 
Shoulder Impingement Evidence Based Case Study
Shoulder Impingement Evidence Based Case Study Shoulder Impingement Evidence Based Case Study
Shoulder Impingement Evidence Based Case Study Rumy Petkov
 
Low Grade Infection after Shoulder Surgery
Low Grade Infection after Shoulder SurgeryLow Grade Infection after Shoulder Surgery
Low Grade Infection after Shoulder SurgeryLennard Funk
 
Arthroscopic Lat Dorsi Transfer 2017
Arthroscopic Lat Dorsi Transfer 2017Arthroscopic Lat Dorsi Transfer 2017
Arthroscopic Lat Dorsi Transfer 2017Lennard Funk
 

Viewers also liked (20)

Shoulder instability (anatomy,types, management )
Shoulder instability (anatomy,types, management )Shoulder instability (anatomy,types, management )
Shoulder instability (anatomy,types, management )
 
Shoulder labral tears MRI
Shoulder labral tears MRIShoulder labral tears MRI
Shoulder labral tears MRI
 
Posterior Instability
Posterior InstabilityPosterior Instability
Posterior Instability
 
Shoulder clinical tests validity eleanor richardson
Shoulder clinical tests validity eleanor richardsonShoulder clinical tests validity eleanor richardson
Shoulder clinical tests validity eleanor richardson
 
Massive rotator cuff tears - decision making 2015
Massive rotator cuff tears - decision making 2015Massive rotator cuff tears - decision making 2015
Massive rotator cuff tears - decision making 2015
 
John Orchard - hamstrings injuries
John Orchard - hamstrings injuriesJohn Orchard - hamstrings injuries
John Orchard - hamstrings injuries
 
Seminar on applied anatomy and surgical approaches to shoulder
Seminar on applied anatomy and surgical approaches to shoulderSeminar on applied anatomy and surgical approaches to shoulder
Seminar on applied anatomy and surgical approaches to shoulder
 
Full thickness rotator cuff tears, Value of clinical tests
Full thickness rotator cuff tears, Value of clinical testsFull thickness rotator cuff tears, Value of clinical tests
Full thickness rotator cuff tears, Value of clinical tests
 
The Cholesterol Conundrum: Final Cut
The Cholesterol Conundrum: Final CutThe Cholesterol Conundrum: Final Cut
The Cholesterol Conundrum: Final Cut
 
Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.Jill Cook: Professor Monash University , Melbourne Australia.
Jill Cook: Professor Monash University , Melbourne Australia.
 
Slideshow: Shoulder Region Posterior
Slideshow: Shoulder Region PosteriorSlideshow: Shoulder Region Posterior
Slideshow: Shoulder Region Posterior
 
The effectiveness of manipulations to the thoracic spine on functional outcom...
The effectiveness of manipulations to the thoracic spine on functional outcom...The effectiveness of manipulations to the thoracic spine on functional outcom...
The effectiveness of manipulations to the thoracic spine on functional outcom...
 
Clinical Examination Of Shoulder
Clinical Examination Of Shoulder Clinical Examination Of Shoulder
Clinical Examination Of Shoulder
 
Post instability walton
Post instability waltonPost instability walton
Post instability walton
 
Shoulder instability
Shoulder instability Shoulder instability
Shoulder instability
 
SCJ instability athletes 2017
SCJ instability athletes 2017SCJ instability athletes 2017
SCJ instability athletes 2017
 
Understanding shoulder instability
Understanding shoulder instabilityUnderstanding shoulder instability
Understanding shoulder instability
 
Shoulder Impingement Evidence Based Case Study
Shoulder Impingement Evidence Based Case Study Shoulder Impingement Evidence Based Case Study
Shoulder Impingement Evidence Based Case Study
 
Low Grade Infection after Shoulder Surgery
Low Grade Infection after Shoulder SurgeryLow Grade Infection after Shoulder Surgery
Low Grade Infection after Shoulder Surgery
 
Arthroscopic Lat Dorsi Transfer 2017
Arthroscopic Lat Dorsi Transfer 2017Arthroscopic Lat Dorsi Transfer 2017
Arthroscopic Lat Dorsi Transfer 2017
 

Similar to Posterior instability of the shoulder lennard funk

Shoulder pain may 2014 ppt
Shoulder pain may 2014 pptShoulder pain may 2014 ppt
Shoulder pain may 2014 pptdgwhitelotus
 
Shoulder Instability
Shoulder InstabilityShoulder Instability
Shoulder InstabilityMANUGOYAL15
 
SLAP PRODROME -PHYSIOTHERAPEUTICS
SLAP PRODROME -PHYSIOTHERAPEUTICS SLAP PRODROME -PHYSIOTHERAPEUTICS
SLAP PRODROME -PHYSIOTHERAPEUTICSDr.Kannabiran Bhojan
 
Posterior shoulder dislocation 2
Posterior shoulder dislocation 2Posterior shoulder dislocation 2
Posterior shoulder dislocation 2Shoulder Library
 
Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care Monis Khan
 
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptxCLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptxMohamedNainar3
 
Chengdu instability clinical examination
Chengdu instability clinical examinationChengdu instability clinical examination
Chengdu instability clinical examinationShoulder Library
 
Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab
Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab
Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab Nicola Taddio
 
Examination of motor system
Examination of motor systemExamination of motor system
Examination of motor systemdina merzeban
 
Seminar rotator cuff
Seminar rotator cuffSeminar rotator cuff
Seminar rotator cuffChapma9
 
Shoulder Joint Examinitaion
Shoulder Joint ExaminitaionShoulder Joint Examinitaion
Shoulder Joint ExaminitaionBharathk79
 
Case Review #26: 73 year old female with Kyphoscoliosis
Case Review #26: 73 year old female with KyphoscoliosisCase Review #26: 73 year old female with Kyphoscoliosis
Case Review #26: 73 year old female with KyphoscoliosisRobert Pashman
 
SHOULDER INSTABILITY.pptx
SHOULDER INSTABILITY.pptxSHOULDER INSTABILITY.pptx
SHOULDER INSTABILITY.pptxgoushady
 
MMorris_SwimmersShoulder
MMorris_SwimmersShoulderMMorris_SwimmersShoulder
MMorris_SwimmersShoulderMegan Morris
 

Similar to Posterior instability of the shoulder lennard funk (20)

Shoulder pain may 2014 ppt
Shoulder pain may 2014 pptShoulder pain may 2014 ppt
Shoulder pain may 2014 ppt
 
Shoulder Instability
Shoulder InstabilityShoulder Instability
Shoulder Instability
 
SLAP PRODROME -PHYSIOTHERAPEUTICS
SLAP PRODROME -PHYSIOTHERAPEUTICS SLAP PRODROME -PHYSIOTHERAPEUTICS
SLAP PRODROME -PHYSIOTHERAPEUTICS
 
Shoulder
ShoulderShoulder
Shoulder
 
Posterior shoulder dislocation 2
Posterior shoulder dislocation 2Posterior shoulder dislocation 2
Posterior shoulder dislocation 2
 
Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care Assessment of shoulder injuries in primary care
Assessment of shoulder injuries in primary care
 
Rotator cuff tears
Rotator cuff tearsRotator cuff tears
Rotator cuff tears
 
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptxCLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
CLINICAL EXAMINATION OF SHOULDER -MOHAMED (1).pptx
 
Chengdu instability clinical examination
Chengdu instability clinical examinationChengdu instability clinical examination
Chengdu instability clinical examination
 
Shoulder dislocation
Shoulder dislocationShoulder dislocation
Shoulder dislocation
 
Shoulder examination
Shoulder examination Shoulder examination
Shoulder examination
 
Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab
Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab
Nicola Taddio Arezzo Nicolas Foundation 2011 Shoulder Cadaver Lab
 
Examination of motor system
Examination of motor systemExamination of motor system
Examination of motor system
 
Seminar rotator cuff
Seminar rotator cuffSeminar rotator cuff
Seminar rotator cuff
 
Shoulder Joint Examinitaion
Shoulder Joint ExaminitaionShoulder Joint Examinitaion
Shoulder Joint Examinitaion
 
avn management
avn managementavn management
avn management
 
Case Review #26: 73 year old female with Kyphoscoliosis
Case Review #26: 73 year old female with KyphoscoliosisCase Review #26: 73 year old female with Kyphoscoliosis
Case Review #26: 73 year old female with Kyphoscoliosis
 
SHOULDER INSTABILITY.pptx
SHOULDER INSTABILITY.pptxSHOULDER INSTABILITY.pptx
SHOULDER INSTABILITY.pptx
 
Hip dislocation
Hip dislocationHip dislocation
Hip dislocation
 
MMorris_SwimmersShoulder
MMorris_SwimmersShoulderMMorris_SwimmersShoulder
MMorris_SwimmersShoulder
 

More from Lennard Funk

ACJ Disloc Management 2022.pdf
ACJ Disloc Management 2022.pdfACJ Disloc Management 2022.pdf
ACJ Disloc Management 2022.pdfLennard Funk
 
Clavicle Fractures Pro Cyclists 2021.pdf
Clavicle Fractures Pro Cyclists 2021.pdfClavicle Fractures Pro Cyclists 2021.pdf
Clavicle Fractures Pro Cyclists 2021.pdfLennard Funk
 
ACJ Osteolysis.pdf
ACJ Osteolysis.pdfACJ Osteolysis.pdf
ACJ Osteolysis.pdfLennard Funk
 
Chronic Pectoralis Major Injuries Len Funk 2020
Chronic Pectoralis Major Injuries Len Funk 2020Chronic Pectoralis Major Injuries Len Funk 2020
Chronic Pectoralis Major Injuries Len Funk 2020Lennard Funk
 
Rotator Cuff Augment 2018.pdf
Rotator Cuff Augment 2018.pdfRotator Cuff Augment 2018.pdf
Rotator Cuff Augment 2018.pdfLennard Funk
 
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxRotator Cuff Update 2022 for Medbelle Len Funk.pptx
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxLennard Funk
 
Should We Repair Rotator Cuff Tears OPN 2017.pdf
Should We Repair Rotator Cuff Tears OPN 2017.pdfShould We Repair Rotator Cuff Tears OPN 2017.pdf
Should We Repair Rotator Cuff Tears OPN 2017.pdfLennard Funk
 
Anterior shoulder instability st4-6
Anterior shoulder instability st4-6Anterior shoulder instability st4-6
Anterior shoulder instability st4-6Lennard Funk
 
ACJ revision surgery for failed reconstructions and excisions
ACJ revision surgery for failed reconstructions and excisionsACJ revision surgery for failed reconstructions and excisions
ACJ revision surgery for failed reconstructions and excisionsLennard Funk
 
Pectoralis Major Injuries for BESS 2020
Pectoralis Major Injuries for BESS 2020Pectoralis Major Injuries for BESS 2020
Pectoralis Major Injuries for BESS 2020Lennard Funk
 
Anterior shoulder Instability in the young athlete 2020 bostaa
Anterior shoulder Instability in the young athlete 2020 bostaaAnterior shoulder Instability in the young athlete 2020 bostaa
Anterior shoulder Instability in the young athlete 2020 bostaaLennard Funk
 
Superior Capsular Reconstruction Outcomes Wrightington 2020
Superior Capsular Reconstruction Outcomes Wrightington 2020Superior Capsular Reconstruction Outcomes Wrightington 2020
Superior Capsular Reconstruction Outcomes Wrightington 2020Lennard Funk
 
Shoulder Instability Sports - Decision Making
Shoulder Instability Sports - Decision MakingShoulder Instability Sports - Decision Making
Shoulder Instability Sports - Decision MakingLennard Funk
 
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...Lennard Funk
 
Pectoralis major allograft reconstruction
Pectoralis major allograft reconstructionPectoralis major allograft reconstruction
Pectoralis major allograft reconstructionLennard Funk
 
What the surgeon wants from radiologist
What the surgeon wants from radiologistWhat the surgeon wants from radiologist
What the surgeon wants from radiologistLennard Funk
 
Rotator cuff tear management 2019
Rotator cuff tear management 2019Rotator cuff tear management 2019
Rotator cuff tear management 2019Lennard Funk
 
Perioperative pain management toni hundle the arm clinic 2019
Perioperative pain management toni hundle the arm clinic 2019Perioperative pain management toni hundle the arm clinic 2019
Perioperative pain management toni hundle the arm clinic 2019Lennard Funk
 
Hydrodistension outcomes 2017
Hydrodistension outcomes 2017Hydrodistension outcomes 2017
Hydrodistension outcomes 2017Lennard Funk
 

More from Lennard Funk (20)

ACJ Disloc Management 2022.pdf
ACJ Disloc Management 2022.pdfACJ Disloc Management 2022.pdf
ACJ Disloc Management 2022.pdf
 
Clavicle Fractures Pro Cyclists 2021.pdf
Clavicle Fractures Pro Cyclists 2021.pdfClavicle Fractures Pro Cyclists 2021.pdf
Clavicle Fractures Pro Cyclists 2021.pdf
 
ACJ Osteolysis.pdf
ACJ Osteolysis.pdfACJ Osteolysis.pdf
ACJ Osteolysis.pdf
 
Chronic Pectoralis Major Injuries Len Funk 2020
Chronic Pectoralis Major Injuries Len Funk 2020Chronic Pectoralis Major Injuries Len Funk 2020
Chronic Pectoralis Major Injuries Len Funk 2020
 
Rotator Cuff Augment 2018.pdf
Rotator Cuff Augment 2018.pdfRotator Cuff Augment 2018.pdf
Rotator Cuff Augment 2018.pdf
 
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
Rotator Cuff Update 2022 for Medbelle Len Funk.pptxRotator Cuff Update 2022 for Medbelle Len Funk.pptx
Rotator Cuff Update 2022 for Medbelle Len Funk.pptx
 
Should We Repair Rotator Cuff Tears OPN 2017.pdf
Should We Repair Rotator Cuff Tears OPN 2017.pdfShould We Repair Rotator Cuff Tears OPN 2017.pdf
Should We Repair Rotator Cuff Tears OPN 2017.pdf
 
Anterior shoulder instability st4-6
Anterior shoulder instability st4-6Anterior shoulder instability st4-6
Anterior shoulder instability st4-6
 
ACJ revision surgery for failed reconstructions and excisions
ACJ revision surgery for failed reconstructions and excisionsACJ revision surgery for failed reconstructions and excisions
ACJ revision surgery for failed reconstructions and excisions
 
Pectoralis Major Injuries for BESS 2020
Pectoralis Major Injuries for BESS 2020Pectoralis Major Injuries for BESS 2020
Pectoralis Major Injuries for BESS 2020
 
Anterior shoulder Instability in the young athlete 2020 bostaa
Anterior shoulder Instability in the young athlete 2020 bostaaAnterior shoulder Instability in the young athlete 2020 bostaa
Anterior shoulder Instability in the young athlete 2020 bostaa
 
Superior Capsular Reconstruction Outcomes Wrightington 2020
Superior Capsular Reconstruction Outcomes Wrightington 2020Superior Capsular Reconstruction Outcomes Wrightington 2020
Superior Capsular Reconstruction Outcomes Wrightington 2020
 
Shoulder Instability Sports - Decision Making
Shoulder Instability Sports - Decision MakingShoulder Instability Sports - Decision Making
Shoulder Instability Sports - Decision Making
 
Scapula Pain
Scapula PainScapula Pain
Scapula Pain
 
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
The Incidence of Traumatic Posterior and Combined Labral Tears in Patients Un...
 
Pectoralis major allograft reconstruction
Pectoralis major allograft reconstructionPectoralis major allograft reconstruction
Pectoralis major allograft reconstruction
 
What the surgeon wants from radiologist
What the surgeon wants from radiologistWhat the surgeon wants from radiologist
What the surgeon wants from radiologist
 
Rotator cuff tear management 2019
Rotator cuff tear management 2019Rotator cuff tear management 2019
Rotator cuff tear management 2019
 
Perioperative pain management toni hundle the arm clinic 2019
Perioperative pain management toni hundle the arm clinic 2019Perioperative pain management toni hundle the arm clinic 2019
Perioperative pain management toni hundle the arm clinic 2019
 
Hydrodistension outcomes 2017
Hydrodistension outcomes 2017Hydrodistension outcomes 2017
Hydrodistension outcomes 2017
 

Recently uploaded

Python Notes for mca i year students osmania university.docx
Python Notes for mca i year students osmania university.docxPython Notes for mca i year students osmania university.docx
Python Notes for mca i year students osmania university.docxRamakrishna Reddy Bijjam
 
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
Basic Civil Engineering first year Notes- Chapter 4 Building.pptxBasic Civil Engineering first year Notes- Chapter 4 Building.pptx
Basic Civil Engineering first year Notes- Chapter 4 Building.pptxDenish Jangid
 
How to Create and Manage Wizard in Odoo 17
How to Create and Manage Wizard in Odoo 17How to Create and Manage Wizard in Odoo 17
How to Create and Manage Wizard in Odoo 17Celine George
 
General Principles of Intellectual Property: Concepts of Intellectual Proper...
General Principles of Intellectual Property: Concepts of Intellectual Proper...General Principles of Intellectual Property: Concepts of Intellectual Proper...
General Principles of Intellectual Property: Concepts of Intellectual Proper...Poonam Aher Patil
 
How to Manage Global Discount in Odoo 17 POS
How to Manage Global Discount in Odoo 17 POSHow to Manage Global Discount in Odoo 17 POS
How to Manage Global Discount in Odoo 17 POSCeline George
 
REMIFENTANIL: An Ultra short acting opioid.pptx
REMIFENTANIL: An Ultra short acting opioid.pptxREMIFENTANIL: An Ultra short acting opioid.pptx
REMIFENTANIL: An Ultra short acting opioid.pptxDr. Ravikiran H M Gowda
 
Application orientated numerical on hev.ppt
Application orientated numerical on hev.pptApplication orientated numerical on hev.ppt
Application orientated numerical on hev.pptRamjanShidvankar
 
80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...
80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...
80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...Nguyen Thanh Tu Collection
 
SOC 101 Demonstration of Learning Presentation
SOC 101 Demonstration of Learning PresentationSOC 101 Demonstration of Learning Presentation
SOC 101 Demonstration of Learning Presentationcamerronhm
 
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...pradhanghanshyam7136
 
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptx
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptxHMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptx
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptxmarlenawright1
 
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptxMaritesTamaniVerdade
 
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...Nguyen Thanh Tu Collection
 
How to setup Pycharm environment for Odoo 17.pptx
How to setup Pycharm environment for Odoo 17.pptxHow to setup Pycharm environment for Odoo 17.pptx
How to setup Pycharm environment for Odoo 17.pptxCeline George
 
NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...
NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...
NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...Amil baba
 
Salient Features of India constitution especially power and functions
Salient Features of India constitution especially power and functionsSalient Features of India constitution especially power and functions
Salient Features of India constitution especially power and functionsKarakKing
 
Jamworks pilot and AI at Jisc (20/03/2024)
Jamworks pilot and AI at Jisc (20/03/2024)Jamworks pilot and AI at Jisc (20/03/2024)
Jamworks pilot and AI at Jisc (20/03/2024)Jisc
 
Graduate Outcomes Presentation Slides - English
Graduate Outcomes Presentation Slides - EnglishGraduate Outcomes Presentation Slides - English
Graduate Outcomes Presentation Slides - Englishneillewis46
 
Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...
Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...
Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...ZurliaSoop
 

Recently uploaded (20)

Mehran University Newsletter Vol-X, Issue-I, 2024
Mehran University Newsletter Vol-X, Issue-I, 2024Mehran University Newsletter Vol-X, Issue-I, 2024
Mehran University Newsletter Vol-X, Issue-I, 2024
 
Python Notes for mca i year students osmania university.docx
Python Notes for mca i year students osmania university.docxPython Notes for mca i year students osmania university.docx
Python Notes for mca i year students osmania university.docx
 
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
Basic Civil Engineering first year Notes- Chapter 4 Building.pptxBasic Civil Engineering first year Notes- Chapter 4 Building.pptx
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
 
How to Create and Manage Wizard in Odoo 17
How to Create and Manage Wizard in Odoo 17How to Create and Manage Wizard in Odoo 17
How to Create and Manage Wizard in Odoo 17
 
General Principles of Intellectual Property: Concepts of Intellectual Proper...
General Principles of Intellectual Property: Concepts of Intellectual Proper...General Principles of Intellectual Property: Concepts of Intellectual Proper...
General Principles of Intellectual Property: Concepts of Intellectual Proper...
 
How to Manage Global Discount in Odoo 17 POS
How to Manage Global Discount in Odoo 17 POSHow to Manage Global Discount in Odoo 17 POS
How to Manage Global Discount in Odoo 17 POS
 
REMIFENTANIL: An Ultra short acting opioid.pptx
REMIFENTANIL: An Ultra short acting opioid.pptxREMIFENTANIL: An Ultra short acting opioid.pptx
REMIFENTANIL: An Ultra short acting opioid.pptx
 
Application orientated numerical on hev.ppt
Application orientated numerical on hev.pptApplication orientated numerical on hev.ppt
Application orientated numerical on hev.ppt
 
80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...
80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...
80 ĐỀ THI THỬ TUYỂN SINH TIẾNG ANH VÀO 10 SỞ GD – ĐT THÀNH PHỐ HỒ CHÍ MINH NĂ...
 
SOC 101 Demonstration of Learning Presentation
SOC 101 Demonstration of Learning PresentationSOC 101 Demonstration of Learning Presentation
SOC 101 Demonstration of Learning Presentation
 
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
 
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptx
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptxHMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptx
HMCS Vancouver Pre-Deployment Brief - May 2024 (Web Version).pptx
 
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
 
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
 
How to setup Pycharm environment for Odoo 17.pptx
How to setup Pycharm environment for Odoo 17.pptxHow to setup Pycharm environment for Odoo 17.pptx
How to setup Pycharm environment for Odoo 17.pptx
 
NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...
NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...
NO1 Top Black Magic Specialist In Lahore Black magic In Pakistan Kala Ilam Ex...
 
Salient Features of India constitution especially power and functions
Salient Features of India constitution especially power and functionsSalient Features of India constitution especially power and functions
Salient Features of India constitution especially power and functions
 
Jamworks pilot and AI at Jisc (20/03/2024)
Jamworks pilot and AI at Jisc (20/03/2024)Jamworks pilot and AI at Jisc (20/03/2024)
Jamworks pilot and AI at Jisc (20/03/2024)
 
Graduate Outcomes Presentation Slides - English
Graduate Outcomes Presentation Slides - EnglishGraduate Outcomes Presentation Slides - English
Graduate Outcomes Presentation Slides - English
 
Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...
Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...
Jual Obat Aborsi Hongkong ( Asli No.1 ) 085657271886 Obat Penggugur Kandungan...
 

Posterior instability of the shoulder lennard funk

  • 2. PLAN Posterior instability:! Pathomechanics! Diagnosis! Management ! Results
  • 3. HISTORY 20th Century! Plethora of surgical techniques ! Poor results (Hawkins, 1984)! Poor understanding
  • 4. POSTERIOR RESTRAINTS 1. Capsule! 2. Labrum – Posterior Bankart! 3. Glenoid Shape
  • 6. POSTERIOR CAPSULE Thin RHAGL! Mid-capsule
  • 7. KIM LESION Seung-Ho Kim. Arthroscopy. 2004
  • 9. GLENOID Version! Deficiencies Semogas, Granville-Chapman & Funk, 2014
  • 11. POSTERIOR INSTABILITY 1. Traumatic 2. Atraumatic
  • 12. ATRAUMATIC Capsular Laxity +/- Muscle Patterning Disorder
  • 13. TRAUMATIC Contact sports! May be minor! Convulsion
  • 14.
  • 15. RUGBY SHOULDER INJURIES Malone, Funk, Mohammed, Ball. Shoulder injury patterns in Rugby - the Collision Shoulder. JBJS (Suppl). 2008. ABER Tackle Direct Impact Neurological Lesion 32% 15% Soft tissue Bankart 79% 33% Bony Bankart 26% 11% Posterior Labral Tear 11% 50% SLAP 7% 35% Partial Cuff Tear 32% 12%
  • 16.
  • 17. Specificity Sensitivity Notes Reference Posterior Drawer Test No data Load & Shift 100% 14% For Laxity Gerber & TRADITIONAL TESTS Ganz. JBJSB. 1984 Posterior Apprehension 99% 20% Jia et al. JBJSA. 2009 Jerk Test 85% 90% posteroinf. labral tear Kim et al. AJSM. 2004 Kim Test 95% 80% posteroinf. labral tear Kim et al. CORR. 1993
  • 18. MODIFIED O’BRIEN’S TEST (MOB)! WRIGHTINGTON POSTERIOR INSTABILITY TEST (WPIT) • Conducted in a similar manner to that initially described by O’Brien • Patient asked to forward flex the affected arm 90° with the elbow in full extension. • Adduct the arm fully, medial to the sagittal plane of the body. • Internally rotate so that the thumb points downward. • The examiner then applies a downward force to the arm being resisted by the patient. • The test is considered positive with objective weakness observed by the examiner when downward force on the arm resulted in loss of forward flexion from 90°. Owen, Mackenzie, Boulter, Funk, 2014
  • 19. MODIFIED O’BRIEN’S TEST (MOB)! WRIGHTINGTON POSTERIOR INSTABILITY TEST (WPIT) Owen, Mackenzie, Boulter, Funk, 2014
  • 20. Specificity Sensitivity Notes Reference Posterior Drawer Test No data Load & Shift 100% 14% For Laxity Gerber & Ganz. JBJSB. 1984 Posterior Apprehension 99% 20% Jia et al. JBJSA. 2009 Jerk Test 85% 90% posteroinf. labral tear Kim et al. AJSM. 2004 Kim Test 95% 80% posteroinf. labral tear Kim et al. CORR. 1993 MOB/WPIT 25% 83% Muscular Athletes Owen et al. IJSS. 2014 POSTERIOR INSTABILITY TESTS
  • 22.
  • 25.
  • 28. POSTERIOR STABILISATION Arthroscopic superseding Open >85% Success at 2 years ! Lower Morbidity! Easier Revision! Treat Associated Pathology:! Reverse HS; SLAP; Anterior Labrum; Rotator Cuff
  • 29. OPEN SURGERY Glenoid bone loss > 25%! Failed Revision soft tissue repairs! Massive Reverse Hill-Sachs Lesion! (Reverse HAGL)
  • 35. POST-OP Phase 1: (Level 1 Exercises) Core stability & Scapula control! Proprioceptive exercises (minimal weightbearing below 90 degrees)! Active assisted ROM as comfortable (in 'safe zone' )! Do not force or stretch No combined adduction & internal rotation Phase 2: (Level 2 Exercises) Progress active assisted to active ROM as comfortable! Phase 3: (Level 3+ Exercises) Regain scapula & glenohumeral stability working for shoulder joint control rather than range! Gradually Strengthen! Sports-specific rehabilitation - Plyometrics and pertubation training
  • 36. RESULTS Badge, Tambe, Funk. Arthroscopic isolated posterior labral repair in rugby players. Int J Should Surg. 2009. 143 shoulders; 32m FU Return to Play = 4.3m! Recurrent Instability = 6/143 (5%) Pre-Op Post-Op Constant Score 65 99 Oxford Score 33 18 Oxford Instability Score 52 13
  • 37. SUMMARY Posterior instability:! Types! Mechanisms! Management ! Results
  • 39. @THESHOULDERDOC Full Time / Part Time LENFUNK@SHOULDERDOC.CO.UK