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Everyone's birthday is ruined! You're welcome! Bursae plural reduce friction and allow smooth gliding between two firm structures, like bone and tendon or bone and muscle. There are over 50 bursae in the human body; the largest is the subacromial bursa under the acromion in the shoulder. The subacromial bursa and the subdeltoid bursa under the deltoid muscle are often considered as one structure.
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This bursa separates the rotator cuff and the deltoid muscle, from the acromion. What are the signs and symptoms of MDI Multidirectional Instability or atraumatic shoulder instability? A thorough history and physical examination are the keys to the diagnosis and treatment of MDI Multidirectional Instability. The classic findings are:. The patient's history may reveal a recent injury, an obvious dislocation, or a change in sport or training that has led to instability in a previously healthy shoulder. A general examination of joint mobility is very helpful.
By moving the arm around in several positions, the doctor can evaluate full shoulder motion. Multidirectional laxity may be present in both shoulders even though only one may be bothersome to the patient. A patient with MDI has an increase in glenohumeral translation shoulder joint movement in multiple directions, and symptoms can be recreated in one or more directions. More than 2 cm of movement during the sulcus test suggests the presence of MDI. The diagnosis of MDI should be based on this result combined with the evaluation of overall shoulder motion and the symptoms triggered when the doctor moves the arm in several directions.
Most patients with MDI can be treated non-operatively with a physical therapy program that emphasizes muscular rehabilitation. Rehabilitation focuses on strengthening the rotator cuff muscles and periscapular muscles those around the scapula. Strengthening these muscles provides dynamic stability to the joint, which is especially important when the static stability provided by the ligaments is lacking. Those who continue with a daily or weekly exercise program as outlined by the doctor are most likely to have a successful recovery.
Athletes may also benefit from sport-specific rehabilitation that includes technique evaluation and modification. Often this type of program can help eliminate faulty technique that may have led to the development of symptoms. Patients who do not get relief from symptoms with a physical therapy program are a treatment challenge.
The most challenging patient to treat surgically is the athlete whose symptoms continue following a rehabilitation program. Often athletes are successful in their sport because of increased laxity in the joint; so surgical intervention should only be considered when the patient has a thorough understanding of MDI, and is aware that stability with surgical correction is always achieved at the expense of motion.
Patients who can voluntarily dislocate the shoulder are poor surgical candidates; surgery is rarely successful for them. The traditional surgery for MDI is designed to make the joint capsule smaller and reduce glenohumeral movement. This open surgical procedure is called an extensive inferior capsular release and imbrication.
Recently, new arthroscopic techniques have been developed to correct multidirectional instability. These arthroscopic techniques are very exciting, but remain experimental, especially for athletes who require stability and the preservation of motion. Post-operative stiffness and loss of motion are also complications; however, loss of motion is often an acceptable result of achieving stability. An average loss of motion in external rotation is about 10 degrees.
Recovery from MDI Multidirectional Instability is a long process that usually requires a six-month physical therapy rehabilitation program. If this succeeds, an ongoing maintenance program to prevent the return of instability symptoms is often necessary.
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If six months of physical therapy has not controlled the instability, surgery may be indicated. MDI refers to a multidirectional laxity of the shoulder joint with associated instability.
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The instability generally results from stretching of the shoulder's supporting ligaments, which leads to increased movement of the glenohumeral joint. The patient's diligence and commitment to a daily maintenance program is required for the best chance of success. How much motion loss will I experience if surgery is needed to stabilize my shoulder?
Motion loss varies. The normal range of shoulder motion at 90 degrees of abduction elbow pointing away from the body is from degrees of external outward rotation the higher number is seen in patients who have developed increased motion for throwing sports. After a surgical stabilization, a stable shoulder will have on average about 90 degrees of external rotation at 90 degrees of abduction. Preliminary results show that arthroscopic procedures may reduce motion loss, but these are still being evaluated.
If I don't want a big incision, can this procedure be performed arthroscopically? Arthroscopic techniques continue to evolve and improve. The short-term follow up data suggests that the success rates of arthroscopic repairs may equal those of open procedures.
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Although the initial results are very encouraging, further long-term studies are required to validate them. Bigliani LU et al.
Operative results of the inferior capsular shift procedure for MDI of the shoulder. Treatment of the shoulder with an exercise program. Savoie FH 3rd. Laser assisted capsulorrhaphy for multidirectional instability of the shoulder.
What does the inside of the shoulder look like? What is atraumatic shoulder instability? Bones and Joints The bones of the shoulder: The humerus is the upper arm bone. This is the "ball" of the shoulder's "ball and socket" joint. In stock. Happy birthday boy loved these candles - as ever. Have the camera ready as they are powerful and it is over fairly swiftly.
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