4] Rehab For Shoulder Athletes Flashcards
Position of anterior shoulder instability
Abducted
ER
Activities with anterior shoulder instability
Tackle
Slide
B-ball
Repeated overhead activities
Assess which nerve with anterior shoulder instability
Axillary
How does posterior instability happen
Repetitive punch
Fall on FF, ADD arm
Often subluxation
MOI for AC joint injury
Direct blow of shoulder into ground
2nd - axial load to elbow
AC joint has pain with
Cross body actions
For simple AC joint injuries: what is RTP
Grade 1 = 7-10 days
Grade 2 = 2-3 weeks
Grade 3 = 4-6 weeks
Ligament stretched
Type 1 AC
Partial rupture AC ligs
Type 2 AC
Complete rupture of AC and CC ligs
Type 3 AC
Clavicle displaced posteriorly over acromion
Type 4 AC
Clavicle displaced just under skin
Type 5 AC
Clavicle under coracoid (very rare)
Type 6 AC
Sprain of the AC ligaments (all ligaments are intact) Deltopectoral fascia is intact
• Radiographic examination is normal
Type 1 AC
Clinical Presentation • • • AC joint tenderness Minimal pain with arm motion No pain in coracoclavicular interspace
Type 1 AC
• Distal clavicle is unstable horizontally (either anteriorly or posteriorly)
Type 2 AC
Clinical Presentation
Distal clavicle slightly superior to acromion
Mobile to palpation
Tenderness in the coracoclavicular space
Minimal pain with arm motion
Type 2 AC
Distal clavicle is unstable horizontally and vertically
• Disruption of the AC ligaments, CC ligaments, and Deltopectoral Fascia
Type 3 AC
Clinical Presentation
•
Distal clavicle appears superior to acromion
Mobile to palpation
Tenderness in the coracoclavicular space
Coracoclavicular widening is evident
AC joint is reducible with upward force on the elbow
Severe pain with motion
Type 3 AC
Distal clavicle is posteriorly displaced into trapezius muscle and into the posterior skin.
Type 4 AC
Clinical Presentation • Maybe anterior dislocation of SC joint Or posterior dislocation of AC joint Tenderness in the coracoclavicular space AC joint is irreducible Pain with motion
Type 4 AC
More severe form of Type 3
• Deltoid and trapezial fascia stripped off acromion and clavicle
Type 5 AC
Clinical Presentation:
Shoulder presents with severe droop
(due to downward displacement of scapula & humerus)
Maybe symptoms from traction on brachial plexus
AC joint is irreducible
Type 5 AC
Inferior dislocation of distal clavicle.
• Disruption of the AC ligaments and Deltopectoral Fascia
Cocoracoclavicular ligaments intact.
Type 6 AC
MOI: Hyperabduction & ER with retraction of scapula(high energy trauma)
Type 6 AC
The shoulder has a flat appearance (prominent acromion)
Associated clavicle and upper rib fractures
Maybe symptoms from traction on brachial plexus
AC joint is irreducible
Type 6 AC
Primary fixation of AC joint
Hook plate
Fixation b/w coracoid process and clavicle
CC screw
Suture loop
Dynamic muscle transfer/ligament reconstruction
Weaver-Dunn
• Autogenous hamstring/Anterior Tibialis allograft
Direct blow to shoulder
• Fall on outstretched arm
- Most common fracture of upper extremity
- Tenderness and crepitus at mid clavicle
Clavicle fracture
Eccentric load to the shoulder with arm abducted• Bench press, tackle football, tactical
PEC major tendon injury
3 surgical options for pec major
Bone trough
Suture anchors
Endosteal button
Fatigue protocol
Standing cable press: 30% BW
• Scaption: 5% BW
• Prone Y: 3% BW
Failure of fatigue protocol
Can’t keep to the beat
Can’t keep form
Volitional fail
