Acute Shoulder Flashcards
What are the 4 pairs of ROM measured at the shoulder?
- flexion/extension
- abduction/adduction
- internal/external rotation
- cross flexion /extension
What an interchangeable term for AC joint sprain? What term does NOT describe this?
Separated shoulder (NOT dislocation)
- used to describe separating the acromion and clavicle in a way it shouldn’t @ AC joint
What are the typical causes / impacts of an AC joint sprain?
Direct blow to the shoulder and FOOSH
Define direct blow to shoulder
Anything where you have a direct impact on the acromion process
Define FOOSH
Fall on outstretched hand
- there is a load from impact that forces humerus up, humerus punches acromion up and forces it away from clavicle
What do the muscles do in response to an AC joint sprain? What problems might it cause?
- Upper traps start working overtime, go into spasm
- PROBLEM because upper traps attach onto lateral 3rd of clavicle & pull on it with contraction, irritating the joint
- does not only show up in AC joint
- quieting in rotator cuff
How does gravity have an impact in AC joint sprains?
-swelling could go down into armpit
- clavicle is much higher than acromion on x-ray cause it gets pulled down, separation is super irritating for ligaments trying to hold the joint together!
- drags arm down
WHY WE USE A SLING
In terms of pain, bruising, or swelling: what happens in ac joint sprain?
Swelling and bruising is pretty localized but could go down into armpit
- greenish bruising below the joint usually
- probably depends on grade of sprain?
What might an AC joint sprain look like?
Clavicle sticking up into skin, tent like appearance
+ acromion left below
What constitutes a type 1 acromioclavicular joint injury?
- AC joint ligament damaged
- AC joint capsule damaged (website says intact?)
- CC ligaments INTACT
- Nicest type, shouldn’t see big gap between clavicle and acromion
DELTOID AND TRAPS INTACT (not mentioned in lecture)
- normal outside appearance, clavicle not elevated
What constitutes a type 2 acromioclavicular joint injury?
- AC joint ligament : ruptured
- AC joint capsule: destroyed
- CC ligaments: start to see damage, sprain
DELTOID AND TRAPS minimally detached
- widened AC joint (7mm) with 25ish % clavicular elevation
What characterizes a type 3 acromioclavicular joint sprain?
AC and CC ligaments ruptured
DELTOID AND TRAPS DETATCHED
Which muscles are involved in AC joint injury?
Anterior deltoid: comes in and attaches along undersurface of clavicle
Upper trapezius: running along upper part of the clavicle, starts to move into med traps (see a little in type 2, definitely in type 3)
If someone has a bony projection closer to their middle chest/sternum, what could this be?
SC joint issue
What are the main 3 types of SC joint issues you could have?
Sprain (some ligament damage, bones not really moved), subluxation (partial dislocation), dislocation (bones are displaced)
Outside of the 3 main joint injuries, what is another you might see at the clavicle? Where would this occur?
Fractured clavicle!
- pretty common, will fracture in area that changes shape/weaker/thinner
- lateral part of clavicle spreads out a little, transition in between medial and lateral will be where 80% of fractures occur
Why could a fractured clavicle and sc joint issues cause serious problems?
- lungs, blood vessels (carotid), trachea, etc are behind so you might impair this with posterior dislocations of SC joint (can be life threatening)
- brachioplexus has a ton of nerves coming together (network) under the clavicle, feeds the arm. If your hand feels strange, this could be the problem
What are the levels of glenohumeral instability?
In order from less severe to more severe:
- sprain
- subluxation (low commitment, feels like humerus shifts but doesn’t fully go out of place)
- dislocation (humerus fully comes out of joint)