Rehabilitation of Gleno-Humeral Joint Dislocation before and after Arthroscopic Reconstruction - Literature review Example

Gleno-Humeral Joint Dislocation Name Institution Rehabilitation of Gleno-humeral joint dislocation before and after arthroscopic reconstruction Bones are basically held by muscles forming a stable joint .A good example of glenohumeral joint is the shoulder joint. It has multiaxial synoviol boll and socket joint, which are involved in articulation between the glenoid fossa of the scapula (shoulder blade) and the head of the humerus (upper arm bone). For better movement the glenoid fossa is shallow and contains the glenoid labrum deepens it and helps in stability. This can withstand 120 degrees of unassisted flexions, making this joint uniquely mobile joint in the body, (Joseph P. Iannotti, 2007). Scapsulohumer rhythm helps in archiving several ranges of movements. The scapula is positioned across the thoracic cage in relation to the humerus. This movement can be compromised anything that would changes the position of the scapula. This could result from an imbalance in the muscle that holds the scapula in its place. The inflicted imbalance at the joint would cause a forward head carriage, which in turn may affects the range of movements normally experienced at the shoulder joint, (James.E, 2000). Pre-operative rehabilitation Gleno-humeral joint dislocation (before the surgery) According to Little, (2008) a study was conducted on treatment of the fractured hip joint. A number of patients with pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoralnail in this prospective, on a randomize series.The walking ability was then compared before the fracture, intra-operative variables and return to where they resided. Patients treated with the proximal femoral nail (n = 42) regained their pre-walking ability within a shorter time depending on age, as young patients were observed to have a steady recovery over the elderly patients. This recovery process took approximately 4 month. The estimated walking ability was (p =0.04). This was rather faster compared to those rehabilitated by use of the dynamic hip screw (n = 41). The glenohumaral joint has a loose capsule that is lax inferiorly. This joint has a high risk of dislocation inferiorly. The joint is surrounded by muscles, a long head of biceps brachii muscle travels inside the capsuleto, attached to the supraglenoid tubercle of the scapula. The glenohumaral joint has a tendon inside the capsule, it requires a synovial tendon to sheath to minimize friction exerted against the bones while flexing within the joint. A number of bursa located in capsule aid mobility, within the glenohumarus joints. They are normally sub deltoid bursa between joint capsule deltoid muscles. Looking at a description given earlier, it is evident that glonehumeral joints are muscle dependant joints. It has branches of anterior and posterior circumflexing the humeral and the suprascapular arteries, which supply blood across the joint, (William D. Bandy, 2007). Gleno-humeral joint dislocations are classified differently. This can be through etiology, direction of instability or even the combination of both. A further classification system distinguishes between the static instabilities, dynamic instabilities, and voluntary dislocation. Static instabilities are defined by absence of static movement symptoms in the two joining body units, (Steven B.Lippitt, 1999). Static joints are associated with rotator cuff or degenerative joint disease. The diagnoses of static joints are normally reported to radiologic other than clinical. The symptoms of dynamic instabilities are initiated by trauma and they may be associated with capsulolabral lesions, defined as glenoid rim lesions, or hyper laxity. They may be unidirectional or multidirectional. However Voluntary dislocation is classified separately since dislocations do not occur inadvertently but under voluntary control of the victim (in this case the patient), (lannotti, 2007). Below is human shoulder joint diagram, showing bones and muscles attached within the joint Source: (Gilles Walch, 1999) The left shoulder and acrom ioclavicular joint and the proper ligaments of the scapula Frozen Shoulders Glonehumeral dislocation may occur as a result of frozen shoulder joints. According to a research conducted by Dalziel (2000) on 73 patients who had frozen shoulders syndrome. The patients were treated within an arthroscopic capsulotomy. The assessments made on any possible pain, function, and a range of motion before the surgery was actually performed. The process of rehabilitating the patients took approximately twelve months (1year). The victims under this circumstance went through different parameters as the surgeons made keen observations. Pain took an average of 2.24 weeks to diminish, range of motion improved to approximated rate of 10%, better than it moved before the surgery. This was achieved in a span of 5.5 weeks after the surgery. After 8.9 weeks patients were discharged, this was success outcome as patients left not restrained with pain and the shoulder experiencing a full range motion. However, there is some mild reaggravation of most patients who felt some pain during the night within the post-operative period. The pain usually settled within the first and second week, with a 37% of these cases reported to have reported during the conducted research. The research further proves, arthoscopic capsulotomy is indeed an effective technique in the management of the frozen shoulders. Post-operative rehabilitation (after the surgery) A post- operative test on patient is normally conducted after the surgery. This is mainly done to proof contribution of specific, capsuloligament structures; it is normally done to restrain inferior-superior translation. Keeping in mind that the joint experiencing tension is only supported by joints, extra care has to be observed, (Joseph P. Iannotti, 2007). A test is done on cadaveric glenohumeral joints using a four degrees-of-freedom test apparatus. The humerus was free to translate in three planes and freely flexes’ and extend when a superior or inferior force 50 Newton is applied. A further test is then performed in three positions of abduction (0, 45 and 90 degrees) and three positions of rotation (neutral, maximum internal, external).The shoulders are then tested while intact, vented, and lastly after divisions of specific capusiloligamantus structure. The primary restraint to inferior translation of the abducted shoulder was the superior gleno-humeral ligament. The coracohumarol ligament appeared to have no significant role. On progressive repeat of the previous abduction process the gleno-humeral ligament becomes the main static stabilizers, resisting inferior translation. The interior portion is the primary capsular restrained at 45 degrees of abduction, posterior portion remained a primary restrained at 90 degrees (Townsend, 1991). According to Labriola (2005) observed Changes in anterior and posterior glenohumeral, a translocation after arthroscopic, nonablative, thermal capsulopasty with a laser. During the observation, a load is directed on the two interior and two posterior, this is applied to the humerus of nine cadaveric glenohumeral joints, and the interior and posterior translation of the humerus on the glenoid is measured .The glenoid has to be rapidly fixed, and the glenohumeral joints positioned at 90 (degrees) of the shoulder abduction and 90 (degrees) of external rotation. Basically this is done to confirm, if the joint has retained its normal movement. Using the holmium-yttrium-aluminum-garnet laser. Thermal energy has to be applied to the interior capsuloligamentous structures. After all that, a second anterior and posterior translation measurement is conducted in the same way it was first done. According to Brunolli (1987), a study was conducted examining the injured shoulders, in particular a history of glenohumeral joint dislocations was done on both shoulders, of 10 healthy subjects and 8 unhealthy subjects. A unilateral anterior dislocation was tested for accuracy of angular reproduction. This was conducted to threshold sensation of movement, end-range reproduction using a motor-driven shoulder-wheel apparatus. A varied analysis was evident, showing significant differences (P Read More