ch 15 pathologies Flashcards
scapulothoracic articulation pathology (scapular dyskinesis)
insidious, pain not localized, incorrectly positioned scapula, loss of strength & endurance
scapulothoracic articulation intervention
remove from aggravating activities, improve scapular function (strength, positioning/mobility, evaluate kinetic chain), pain control
sternoclavicular (SC) joint sprain MOI
longitudinal force on clavicle, FOOSH, hit on lateral portion of shoulder, traction forces
sternoclavicular joint sprain S&S
localized pain, pain with protraction & retraction & joint play, tilt head toward injured joint for comfort, rapid swelling if dislocated
what do you have to rule out for a sternoclavicular joint sprain?
epiphyseal injury
what would be considered an emergency with a SC joint sprain? why?
posterior dislocations, threat to subclavian artery & vein
SC joint sprain intervention (sprains & dislocation)
sprain- pain control, immobilize in sling, ROM, strengthening, functional training
dislocation- closed reduction or open reduction with joint stabilization with immobilization, rehab, surgery (uses hamstring tendon)
acromioclavicular joint pathology MOI
acute- FOOSH, blow to superior acromion process
chronic- repetitive stress, joint degeneration
AC sprain S&S
pain localized to AC joint, possible step deformity, pain with shoulder movements
what do you have to rule out for an AC sprain?
distal clavicular fracture
AC sprain intervention (grade I, II, III)
grade I, II & degenerative conditions- conservative treatment with early ROM & strengthening, immobilize for pain control (if necessary)
grade III or higher- surgery or conservative treatment (depending on activity level), immobilize, ROM, strengthening (include scapula)
glenohumeral instability
can be anterior, posterior, or inferior/multidirectional
anterior glenohumeral instability structures involved
laxity of anterior stabilizing structures, middle GH ligament, anterior band of inferior GH ligament, superior GH ligament, rotator cuff weakness/tear, glenoid labrum
non traumatic anterior instability
MOI- repetitive overhead throwing, use caution when should externally rotates (especially above 90 of abduction)
traumatic anterior instability
MOI- forced excessive external rotation & abduction, many tissues can be damaged, common to repeat
traumatic & non traumatic anterior instability treatment
nonoperative- immobilization followed by rehab, ROM, strength, neuromuscular control, function, include scapular area too
surgery- possible for structural damage (labrum)
posterior instability structures
laxity of posterior stabilizing structures, GH joint capsule and labrum
non traumatic posterior instability
MOI- repetitive stress (humerus flexed & internally rotated with longitudinal force placed on humerus), pain with horizontal adduction or loading of posterior GH joint
traumatic posterior instability
MOI- posteriorly directed force with humerus flexed and adducted, difficult to diagnose, prominent coracoid process, unable to externally rotate shoulder joint
non traumatic & traumatic posterior instability treatment
rehab & activity modification, surgical repair for damaged structures
inferior/multidirectional instability
