Chp 22 The Shoulder Complex Flashcards
Setting phase of scapulohumeral rhythm
The humerus is abducted to 30 degrees, and no movement of scapula
Scapulohumeral rhthym after the setting phase
2:1 ratio of glenohumeral to scapulothoracic movement
For the scapula to abduct and upwardly rotate to 180 degrees, how much movement must occur at the clavicle?
Clavicle must elevate 20 degrees and rotate in a posterior direction at least 30 degrees
List seven exercises that are beneficial for throwers warm up, and why
- External rotation at 90 degrees of abduction
- Throwing deceleration
- Humeral flexion
- Humeral extension
- Low scapular rows
- Throwing acceleration
- Scapular punch
-These muscles activate all muscles of the rotator cuff, primary humeral movers, and scapular stabilizer muscles which are all important to throwing motion
One scapula sitting higher than they other is indicative of what deformity?
Sprengels deformity, congenital deformity in which the scapula does not descend
A winged scapula on both sides vs one sides indicates?
-both sides-weakness of serratus anterior muscles
-one side- long thoracic nerve injury, or scoliosis
Clavicular fractures etiology
-fall on outstretched arm
-fall on tip of shoulder
-direct impact
Most common site for clavicular fracture
Middle 1/3 of bone from direct impact, usually greenstick fracture
Clavicular fractures S&S
-suuports arm on the injured side, tilts head toward injured side, chin turned to opposite side
-clavicle will appear slightly lower than the unaffected side
-Swelling, point tenderness, mild deformity
Clavicular fracture management
-apply sling and swathe bandage
-treat for shock if necessary
-If x-ray shows a fx, physician attempts closed reduction followed by immobilization w/figure eight brace maintained for 6-8 weeks
-after immobilization, gentle isometric and mobilization exercises should begin while patient wears a sling for additional 3-4 weeks
Scapular fracture etiology
-occur as a result of direct trauma/force transmitted through the humerus to the scapula
-fx occur to the body, glenoid, acromion, and coracoid
Scapular fracture S&S
-pain w/shoulder movement
-swelling, point tenderness
Scapular fracture management
-place in a sling and refer for x-rays
-supported in a sling for 3 weeks, overhead strengthening exercises beginning at week 1
Humeral shaft fracture etiology
-direct blow or fall on the arm
-type of fracture: comminuted/transverse
-can result in radial nerve (which encircles the humerus) to be severed by jagged bone edges causing radial nerve paralysis, wrist drop, and inability to supinate the forearm
Proximal humerus fracture etiology
-result from a direct blow, fall on outstretched arm , dislocation
-most fractures take place at the surgical neck
-fracture can be mistaken for a shoulder dislocation
Epiphyseal humeral fracture etiology
-Epiphyseal (head of the humerus) fractures occur more often in individuals 10 years old and younger
-caused by direct blow, or indirect force traveling along the length of the axis of the humerus
-Causes shortening of the arm, disability, point tenderness, swelling, and pain
Humeral fractures S&S
-pain, inability to move the arm, swelling, point tenderness, discoloration of superficial tissue
- bc of proximity of axillary blood vessels and brachial plexus, fx to upper end of humerus can result in severe hemorrhaging or paralysis
Humeral fracture management
-Splint, treat for shock , refer to physician
-fx to humeral shaft: out for 3-4 mo
-proximal humerus fx: sling and swathe bandage, refer to physician, out for 2-6 months
-epiphyseal fx: immobilized for 3 weeks, main concern is damage to the growth plate
Sternoclavicular sprain etiology
-indirect force transmitted through humerus, blow to clavicle, torsion of posteriorly extended arm
Sternoclavicular sprain S&S
-Grade 1: little pain/discomfort, some point tenderness, no deformity
-Grade 2: subluxation of joint w/visible deformity, pain, swelling, point tenderness, inability to abduct/horizontally abduct shoulder in full range
-Grade 3: Complete dislocation and gross displacement of clavicle at the sternal junction, swelling, disability indicative of complete rupture of sternoclavicular and costoclavicular ligaments
What complications are associated with a posteriorly dislocated clavicle?
-pressure placed on blood vessels, esophagus, or trachea can lead to life/death situation
Sternoclavicular sprain management
-POLICE: protection, optimal loading, ice, compression, elevation
-reduction of clavicle by physician and immobilization for 3-5 weeks
-high incidence of recurrence w/sc sprains
Acromioclavicular sprain etiology
-Direct impact to the tip of the shoulder: forcing the acromion process downward, backward, and inward, while clavicles pushed down against the rib cage
-upward force exerted along long axis of humerus by fall on outstretched arm
-may sustain contusion to distal end of clavicle
Grade 1 ac sprain S&S
-point tenderness at acromion process and outer end of clavicle
-no disruption of ac joint, mild stretching of acromioclavicular and coracoclavicular ligaments
Grade 1 ac sprain S&S
-point tenderness at acromion process and outer end of clavicle
-no disruption of ac joint, mild stretching of acromioclavicular and coracoclavicular ligaments
Grade 2 ac sprain S&S
-Tearing/rupture of acromioclavicular ligaments, stretching of coracoclavicular ligaments
-displacement and prominence of lateral end of clavicle
-point tenderness at injury site
-unable to fully abduct/horizontally abduct
Grade 3 ac sprain S&S
-complete rupture of acromioclavicular and coracoclavicular ligaments
Grade 4 ac sprain S&S
-posterior separation of the clavicle
-complete disruption of the acromioclavicular ligament, coracoclavicular ligaments may sometimes remain intact
Grade 5 ac sprain S&S
-complete rupture of acromioclavicular and coracoclavicular ligaments along w/tearing of trapezius and deltoid attachment to the acromion
-gross deformity and prominence of distal clavicle
-sever pain, loss of movement, instability of shoulder complex
Grade 6 ac sprain S&S
-clavicle displaced inferior to the coracoid behind the coracobrachialis tendon
Ac sprain managment, list management for grades 1-6
- Application of cold and pressure to control local hemorrhage
- Stabilization of the joint by a sling and swathe bandage
- Referral to a physician for definitive diagnosis and treatment
Grade 1-sling for 3-4 days
Grade 2-sling 10-14 days
Grade 3-sling for 2 weeks, nonoperative
Grades 4-6: surgical intervention using open reduction and internal fixation
Glenohumeral joint sprain etiology
-Anterior capsule sprain: arm forced in abduction
-External rotation, direct blow
-Posterior capsule sprain: humerus forced posteriorly when arm is flexed
What muscle group is most effective in controlling external rotation of the humerus and reducing ligamentous injury?
Infraspinatus-teres minor group
Glenohumeral joint sprain S&S
-pain during movement especially when moi is reproduced
-decreased rom and pain w/palpation
Glenohumeral joint sprain managment
-use of cold pack for 24-48 hours, compression, rest and immobilization in a sling
-after hemorrhage subsides, cryotherapy/massage/ultrasound added and mild passive and active rom to regain full ROM
-After full rom, resistance exercises added
What is the most common shoulder dislocation?
Anterior/inferior dislocations (account for 95% of all dislocations)
Anterior/inferior glenohumeral dislocation MOI
-direct impact to the posterior/lateral aspect of the shoulder
-most common moi: forced abduction, external rotation, and extension forcing humeral head out of glenoid cavity
-can result in a detached labrum and bankart lesion, and hill-sachs lesion
Soft bankart lesion
Anteriorinferior labrum tears from the glenoid and injury only involves soft tissue (most common)
Bony bankart lesion
Anteriorinferior labrum tears and a part of the bony glenoid fractures of breaks off
Superior labrum anterior/posterior (SLAP) lesion
Caused by an injury to to the superior part of the labrum that begins posteriorly and extends anteriorly, affects the attachment of the long head of the biceps into the superior labrum
Posterior glenohumeral dislocation MOI
Forced adduction, internal rotation, or fall on extended and internally rotated arm
-result in reverse hill-sachs lesion
Reverse hill-sachs lesion
Occurs on anteromedial portion of humeral head following a posterior shoulder dislocation
Anterior glenohumeral dislocation S&S
-flattened deltoid contour, prominence of humeral head when palpating axilla
-patient carries arm in slight abduction and external rotation and is unable to touch opposite shoulder
Posterior glenohumeral dislocation S&S
-arm often held in adduction and internal rotation
-anterior deltoid muscle is flattened
-acromion and coracoid processes prominent
-head of humerus may be seen posteriorly
Glenohumeral dislocation management
-immediate immobilization in a position of comfort using sling and pillow/folded towel
-reduction by physician, (1st time dislocations often associated with/fx shouldnt be reduced by ats)
Reducing anterior vs posterior glenohumeral dislocations
-anterior-can be done on the sideline by applying sustained traction while patient relaxes
-posterior-may have to be performed while patient is under anesthesia
