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A 22-year-old female snowboard instructor is referred to an outpatient physical therapy clinic from a medical center with a diagnosis of right shoulder pain. She fell while snowboarding 3 days ago and reports that her shoulder "popped out and went back in again." She attempted to teach today, but was unable to continue due to pain and a sense that her shoulder would "come out again" if she tried to help one of her fallen clients to stand up. Plain film images taken at the clinic showed no obvious bony abnormality; no additional imaging was performed. The patient's medical history is otherwise unremarkable. Signs and symptoms are consistent with anterior shoulder dislocation. The patient's goal is to continue snowboarding and teaching for the rest of the season.

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What examination signs may be associated with this diagnosis?

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What are the most appropriate examination tests?

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What precautions should be taken during physical therapy examination and interventions?

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What are the most appropriate physical therapy interventions?

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What referral may be appropriate based on her condition?

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What is her rehabilitation prognosis?

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ALPSA LESION: Acronym for anterior labroligamentous periosteal sleeve avulsion; an anteroinferior labral detachment associated with a stripped, but continuous glenoid periosteum

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BANKART LESION: Avulsion of the labrum and inferior glenohumeral ligament from the anteroinferior glenoid rim1

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HAGL LESION: Acronym for humeral avulsion of the anterior glenohumeral ligament

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HEMARTHROSIS: Bleeding into a joint

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HILL-SACHS LESION: Impression fracture of the posterosuperior articular surface of the humeral head caused by translation of the humeral head over the glenoid rim2

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SHOULDER DISLOCATION: Complete disruption of the humeral head from the glenoid fossa due to a force that overcomes the joint's static, capsulolabral, and dynamic restraints3

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SHOULDER SUBLUXATION: Increased excursion of the humeral head on the glenoid fossa without complete displacement; also known as an incomplete or partial dislocation3

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SLAP LESION: Tear of the superior labrum, anterior to posterior

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  1. Describe the mechanism of injury and the resulting pathoanatomy associated with an anterior shoulder dislocation.

  2. Identify the risk factors for primary and secondary dislocations.

  3. Describe the benefits and risks related to conservative treatment and surgical intervention following a first-time anterior shoulder dislocation.

  4. Prescribe an appropriate therapeutic exercise program for a patient who elects conservative treatment following a first-time anterior shoulder dislocation.

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PT considerations during management of the individual with a diagnosis of acute anterior shoulder instability:

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  • General physical therapy plan of care/goals: Decrease pain; minimize loss of neuromuscular control and strength; restore functional joint stability
  • Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; patient education regarding treatment options; ...

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