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Kin 2236 Athletic Injuries > (2) Lecture 8: The Athlete's Shoulder > Flashcards

(2) Lecture 8: The Athlete's Shoulder Flashcards

1
Q

Shoulder Complex

A

Humerus + scapula (articulation w/ Ac, SC jts and thoracic wall)

  • great mobility b/c of minimal bony congruity
  • works with musculature and ligaments to maintain instantaneous centre of motion of GH jt.
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2
Q

Shoulder Girdle

A

CLAVICLE + SCAPULA

  • connects upper limb to axial skeleton
  • clavicle attaches medially to manubrium of sternum and laterally to acromion of scapula
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3
Q

Shoulder Separation

A

affects ACROMIOCLAVICULAR (AC) jt.

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4
Q

Shoulder Dislocations

A

affect
- glenohumeral jt.
- sternoclavicular (SC) jt.

usually blowing a ligament

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5
Q

Shoulder Fractures

A

affect
- clavicle
- humerus
- scapula

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6
Q

Shoulder Tendonitis/osis

A

affects rotator cuff

common in overhead athletes

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7
Q

Shoulder Strains

A

affect
- rotator cuff
- scapular stabilizers

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8
Q

Sternoclavicular joint

A
  • clavicle articulates w/ manubrium to form SC jt.
  • only 25% of clavicle’s surface area in contact = LEAST bony stability in chain
  • integrity of jt. is from strong ligament attachment
  • shock absorber (disc)
  • only direct connection btwn. upper extremity and trunk
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9
Q

SC jt movement

A
  • important for all movements, especially ABDUCTION
  • clavicle moves freely fwd/bwd and up and rotate

When arm moves thru flexion/abduction, the clavicle retracts, elevates and rotates posteriorly

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10
Q

SC jt stability

A

Strong ligaments maintain integrity

Sternoclavicular lig: stops from popping fwd

Interclavicular lig: helps w/ depression

Costoclavicular lig: stops from popping up

Articular disk: shock absorber

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11
Q

SC injury

A
  • MVA and sports injuries are common causes

MOI
- direct blow to clavicle
- indirect through arm or shoulder (lands on one of them)

  • clavicle usually moves UPWARD/FORWARD
  • if posterior, it is a medical emergency b/c it can affect the subclavian v. + a., trachea, esophagus
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12
Q

Anterior dislocations of SC jt.

A

rarely occur as a result of direct trauma

  • force applied to ANTEROLATERAL clavicle = shoulder rolls backward
  • usually caused by INDIRECT force
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13
Q

Posterior dislocations of SC jt.

A

typically due to DIRECT force to ANTEROMEDIAL clavicle

can also happen when a force is applied to posterolateral shoulder, making the shoulder roll fwd

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14
Q

Grade 1 SC injury

A
  • Slight pain and tenderness
  • no deformity
  • little to no laxity
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15
Q

Grade 2 SC injury

A
  • sublux (some laxity)
  • defomity
  • swelling and pain
  • unable to abduct or bring arm across chest
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16
Q

Grade 3 SC injury

A

complete displacement of clavicle

  • gross laxity
  • NO endpoint
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17
Q

Management of SC injury

A
  • posterior injury = send to ER
  • anterior injuries are reduced w/ LATERAL TRACTION
  • POLI? Peace + Love (minus compression and elevation)
  • high incidence of re-injury
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18
Q

Clavicle

A
  • S shaped bone

Functions
- protects neurovascular bundle (brachial plexus)
- muscle attachment
- bony attachment of shoulder

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19
Q

Clavicle fractures

A
  • one of most common sport fractures

MOI
- can be injured w/ any force that brings SHOULDER TO MIDLINE
- or direct force from superior or anterior direction
- or indirect force (fall on point of shoulder OR fall on outstretched arm)

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20
Q

Signs and Symptoms of clavicle fractures

A
  • usually MIDDLE 1/3 (NOT medial 1/3) w/ outer fragment dropping down
  • can be distal tip
  • lots of pain
  • localized tenderness and swelling

will have
- loss of function
- spasm of trapezius + SCM
- arm held to body w/ shoulder elevated
- scapula is protracted

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21
Q

Management of clavicle fractures

A
  • pain relief
  • POLICE
  • sling : B-TUBE (NOT A-tube b/c sling hangs over clavicle = weight on clavicle)
  • figure 8 brace to avoid foreshortening (less common now)
  • usually heals in 4-6 weeks
  • keep arm moving BELOW 90 degrees (nothing above shoulder height until healed)
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22
Q

Acromioclavicular jt. stability

A

Provided by different structures:
1. Coracoclavicular ligs (VERTICAL stability)
- conoid
- trapezoid

  1. Acromioclavicular ligs (ANT.-POST. stability)
  2. Capsule
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23
Q

AC separations

A

MOI
- direct: point of shoulder w/ arm abducted (MOST COMMON)
- indirect: fall out on outstretched hand (force comes up through)

Graded 1-6
- 1-3 are most common
- 4-6 are surgical

24
Q

Grade 1 AC separation

A
  • small tear of capsule of AC jt
  • NO instability of jt./NO laxity
  • pain on palpation
  • A-P + vertical stability present
  • no anatomic changes
  • full ROM w/ pain near EOR (end of range)
25
Q

Grade 2 AC separation

A
  • complete tear of AC jt capsule + ligaments
  • small tear of coracoclavicular lig
  • slight A-P spring
  • no ant-post stability (still have vertical stability)
26
Q

Grade 3 AC separation

A

complete tear of AC ligament and coracolavicular lig.

  • looks physically different from Grade 1/2
  • step deformity: raised distal end of clavicle + depressed acromion
  • clavicle pops up + shoulder pops down
  • 45 degrees or less ROM
27
Q

Cross Flexion

A

like throwing a scarf over shoulder
- lots of pain if AC jt. is affected

28
Q

AC shear

A

pushing AC jt. fwd + back

29
Q

Grade 5 AC separation

A

like type 3

  • deltoid + trapezial fascia stripped off

clavice points STRAIGHT UP

30
Q

Grade 6 AC separation

A

DOWNward displacement of clavicle

C5-6/Brachial plexus at risk

31
Q

Management of Grade 1 AC separation

A
  • clinically stable but very painful
  • tape for comfort
  • get them out of sling
  • POLICE/PEACE&LOVE
  • can go back as soon as pain allows

Goal: keep shoulder moving for return to play ASAP
- maintain ROM, strength and function

32
Q

Management of Grade 2/3 AC separation

A

Inflammation/Destruction phase
- POLICE/PEACE&LOVE
- stabilize w/ tape

Repair Phase
- gentle AROM then progress to full ROM
- shoulder isometrics, progress to concentric
- scapular stabilizer strengthening

Remodeling Phase
- full strength at shoulder
- good scapulothoracic mechanics

33
Q

Criteria for return from shoulder girdle injuries

A
  • medical clearance
  • full ROM
  • strength within 90% of unaffected side
  • full function
  • able to PROTECT THEMSELVES
34
Q

Return time after AC jt. injury

A

Grade 1: 7-10 days
Grade 2: 2-3 weeks
Grade 3: 4-12 weeks
Grades 4-6: Surgical

35
Q

ICOM

A

Instantaneous Centre of Motion of GH jt
- maintained by shoulder complex working w/ musculature and ligaments

  • Boney structures keep articulation in contact
  • Rotator cuff muscles compress and centralize humeral head (move thru space)
  • Scapular stabilizers help position for scapula for max stability
36
Q

Glenohumeral Jt.

A
  • humeral head is 3x the size of laterally facing glenoid
  • labrum deepens the socket
  • scapula must rotate UNDER to support humerus during movement
37
Q

Static and Dynamic Shoulder Support

A

Static support
- labrum
- capsule
- glenohumeral ligaments
- shape of bones

Dynamic support
- rotator cuff (MOST)
- scapular stabilizers

38
Q

Posterior + Superior Shoulder Support

A
  • spine of scapula + acromion
  • thick capsule
  • RC (rotator cuff) muscles crossing posterior jt
39
Q

Anterior Shoulder Support

A
  • minimal bony support
  • biceps (long head attaches to labrum)
  • jt. capsule and ligaments
40
Q

Static stabilizers capusle/ligaments

A
  • capsule around shoulder jt. has THICKENINGS

Thickenings are the ligaments
- Superior (SGHL), middle (MGHL), inferior (IGHL)
- IGHL is commonly inured

  • ligaments rotate w/ movement
  • in abduction + external rotation, anterior IGHL “fans out” and rotates anteriorly + superiorly to prevent subluxation of shoulder
41
Q

Most commonly injured GH ligament

A

Anterior IGHL
- main stopping force for anterior movement

42
Q

Rotator Cuff muscles

A
  1. subscapularis (internal rotation)
  2. supraspinatus (abduction)
  3. infraspinatus
  4. teres minor

maintain humeral head in glenoid + help w/ movement

43
Q

Normal GH jt Movement Patterns

A
  1. Setting Phase
    - initial 30 degrees, the scapula does NOT move as it establishes a stable base
    - rotator cuff muscles drive movement
  2. After setting phase, there is a 2:1 ratio btwn the humerus and scapula
44
Q

Force Couple - Scapulothoracic jt.

A

0-90 degrees of shoulder abduction: UPPER fibres of trap + serratus anterior drive motion

above 90 degrees of shoulder abduction: LOWER fibres of trap + serratus anterior drive motion

45
Q

Dislocated Shoulder

A

Traumatic - TORN loose (TUBS)

Atraumatic - BORN loose (AMBRI)

46
Q

Traumatic dislocated shoulder

A

TORN loose (TUBS)

Traumatic
Unilateral lesion
Bankart (torn labrum)
Surgery required

  • single force applies excessive overload to passive restraints
  • often damages the glenoid (Bankart) and humerus (Hill-Sachs lesion)
47
Q

Atraumatic dislocated shoulder

A

BORN loose (AMBRI)

Atraumatic
Multidirectional
Bilateral (frequently)
Rehabilitation (responds well)
Inferior capsular shift needed

  • born lax ppl or functionally lax secondary to repetitive microtrauma
  • loose capsule
48
Q

Torn Loose - Anterior dislocation

A

95% of dislocations happen ANTERIORLY

MOI
- forced external rotation usually ABDUCTED or FOOSH

Signs + symptoms
- arm held slightly externally rotated + abducted
- restricted ROM
- altered contour of shoulder

49
Q

Subcoracoid dislocation

A

Flat looking shoulder

50
Q

Apprehension Test

A

For shoulder instability
- for previous dislocations not recent

Hand overhead and pull forearm out away from shoulder

Patient will:
TELL you to stop
ROLL their body towards the arm
FIGHT what you are doing
PULL the arm to the body

51
Q

Inferior Dislocations

A

accounts for 1%

MOI
- arm in excessive ABDUCTION and a force is taken pushing humeral head inferiorly out of glenoid

Signs and symptoms
- similar to anterior dislocation
- arm held slightly externally rotated + abducted
- restricted ROM
- altered contour of shoulder

52
Q

Posterior dislocations

A

EASILY MISSED (need side view X-ray)
- accounts for 4%
- often due to seizure or electric shock

MOI
- arm in FLEXION + ADDUCTION
- force is taken on hand = humeral head pushes out glenoid posteriorly
- elbow held at side w/ hand or stomach

CANNOT externally rotate or abduct

53
Q

Born loose - Subluxing shoulders

A
  • seen in individuals w/ chronic instability
  • AMBRI: multiple jt laxities in multiple directions w/ frequent subluxations
  • can be acquired from repetitive trauma + poor stretching of a jt

may experience DEAD ARM w/ humeral subluxation
- due to traction/`impingement of neurovascular structures causing weakness/numbness

54
Q

Management of Traumatic/Atraumatic Injuries

Inflammatory phase

A
  • POLICE/PEACE&LOVE
  • PROTECT
  • exercise: gentle ROM (NO ext. rot./abd)
  • isometric strength
  • keep elbow + wrist moving
  • sling is probably not best b/c of slight external rotation
55
Q

Management of Traumatic/Atraumatic Injuries

Repair/Fibroblastic phase

A
  • gain ROM, slowly working to abov shoulder height
  • continue functional strengthening + work thru range
  • begin proprioception exercise
  • subluxers/born loose patients may start here
56
Q

Management of Traumatic/Atraumatic Injuries

Remodeling phase

A

Functional training for return to play
- idealize strength through range
- add in power (strength+speed)
- bracing/taping

Kin 2236 Athletic Injuries (20 decks)

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