conditions of the shoulder Flashcards
what does the sternoclavicular joint attach
it attaches the axial skeleton to the appendicular skeleton (clavicle to the sternum)
what muscles attach to the SC joint
pec major and SCM
what mvt does the sc joint do
flex/ext, int and ext rotation, abd and add
what injuries can occur at the sc joint
foosh (compression of that joint, protecting yourself while falling), direct trauma, contact to lateral sh (bumped into wall), sprain (ant and post, big could be torn 1 or 2 degrees) and dislocation (ant, post)
which one is most common; ant dislocation of sc joint or post?
ant dislocation
what is so bad about a post dislocation of the sc joint
it can compromise abc (lung, trachea and esophagus are there)
S/S of sc joint sprain (7)
pain w mvt of gh joint (shearing forces)
pain w breathing (especially deep breathing; m. that help with breathing will move the clavicle too)
pain w upright posture (opposite w post sprain)
pain w sleeping on side (compressing the sc joint)
clicking sensation at sc joint (lig torn so b on b rubbing)
bruising or swelling maybe present (if n. is affected)
where is the acromioclavicular joint
lateral aspect of the shoulder, clavicle and the acromion process of the scapula
what ligs stop the clavicle from moving ant and post on the acromion
ac ligament
what lig prevents the clavicle and acromion from moving post and inf
cc ligament
if inf ac joint sprain what m. do you need to strengthen
deltoid and pec major
what m. needs to relax if theres an inf ac joint sprain
utf
what injuries can occur at the ac joint
sprain of ac lig and or cc lig foosh (humerus jammed in subacromion) direct blow to the lateral shoulder blow to sup acromion (smt falls on side of sh) separated sh (ac joint vs dislocation)
structures involved and s/s of type 1 ac joint sprain
slight to partial damage of ac lig and capsule
point tenderness and no laxity or deformity
structures involved and s/s of type 2 ac joint sprain
rupture of ac lig and partial damage to cc lig
slight laxity and deformity of ac joint, slight step deformity
structures involved and s/s of type 3 ac joint sprain
complete tear of ac lig and cc lig, possible involvement of delts and traps fascia
obvious dislocation of the distal end of clavicle from acromion process
structures involved and s/s of type 4 ac joint sprain
complete tearing of ac and cc lig and tearing of deltoid and trap fascia
post clavicular displacement into the insertion of the uft
structures involved and s/s of type 5 ac joint sprain
complete tearing of ac and cc lig and tearing of deltoid and trap fascia (deformity is even larger than type 4)
displacement of the clavicle 3x height compared to other side
structures involved and s/s of type 6 ac joint sprain
complete tearing of ac and cc lig and tearing of deltoid and trap fascia (deformity is even larger than type 5)
displacement of clavicle inferiorly under coracoid
what types of ac joint sprain can’t be told appart by naked eye
type 3, 4 and 5 and diff by imaging
common s/s of ac joint sprain (4)
pain w mvt of gh joint (especially limited rom in flex/abd/CROSS FLEXION)
STEP DEFORMITY
some bruising may be present
pin point pain on ac joint
what is the most commonly fractured b of the upper body and where is it most commonly fx
clavicle and at the turn of it
what are the moi possible w clavicular fx (3)
direct impact, impact to lateral shoulder and foosh
diff btw clavicular fx and ac joint sprain
crepitus and if in the middle and not on the ac joint then its a fx
what to do if athlete has equipment for a clavicular fx
pmsc, check rom (will move more if ac and no fx), brush hand to check for major deformity and then palpate only if minor deformity
what structures are included in the gh joint and what type of joint is it
head of humerus and glenoid fossa of scap
dynamic joint; works w scap and clavicle to ensure full rom
what structures make up the gh joint
labrum (reduces friction and increases rom, deepens the joint) gh lig (sup, middle/ant, inf, post) biceps, rotator cuff, pec major, delts, triceps, lat dorsi, coracobrachialis
what instabilities are possible at the gh joint and what does that instability increase
ant, post, inf or multiple directions (some people can be hypermobile and born w it, can sublax no prob)
it will increase laxity and so rom too
instability at the gh joint is graded on what
joint play; mvt of head of humerus in glenoid fossa
what types of stability are possible at the gh joint and what structures does each one involve
passive stability; capsular lig and gh lig (all blend in together)
dynamic stability: ROTATOR CUFF M, and other gh muscles (pecs, traps, delts, biceps and triceps)
what test can be done to test gh instability
apprehension test; ant mvt of head of humerus
what is TUBS gh instability and how is it fixed
traumatic unidirectional instability usually treated w surgery (usually bankart lesion; little fx to rim of glenoid fossa= shearing forces)
what is AMBRI gh instability and how is it fixed
atraumatic, multidirectional frequently bilateral treated w rehab and/or inf capsular shift (shrink capsule to make it tighter to keep head of humerus in)
moi of gh instability
traumatic:
- apprehension position (cte throwing motion)
- foosh (ant/post)
- direct trauma (missed tackle)
chronic:
- large strains or weakness of rc (should normally help keep hoh inside)
- dysfunction of long head of biceps tendon (ant stabilizer of shoulder)
- apprehension position- repetitive
- genetics (hyperlax people)
what are the diff types of shoulder dislocations and which is more common
anterior (more common) and posterior dislocations
what can anterior instability of gh cause
laxity (middle gh lig, ant aspect of the inf lig)
sprains
dislocations
what other problems can an anterior instability cause and what can be the s/s
brachial plexus problems; tingling, numbness on arm and always check pmsc
what is the position of the humerus in a posterior instability of the gh joint
its flexed and internally rotated
is a posterior instability common and is it more observed as a microtrauma or an acute inj
very rare (about 3% of all sh instabilities) more common as microtrauma (repeated blows to a flexed arm, follow thru phases of overhead throwing)
what are the two types of multidirectional instabilities
congenital: generalized hyper laxity of the sh and other joints (hyperlax joints all over the body)
acquired: participation in overhead activities that impose repetitive microtrauma (inj will happen at end rom so need to strengthen the m. to stabilize that end rom)
s/s of gh instability (7)
- complains of instability feeling
- moi of dislo or sublux
- pain w mvt at gh joint (pain/apprehension in abd, ext rot = ant instability) (pain/apprehension w closed kinetic loading = post)
- m. imbalances (inj makes m. shut down)
- poor posture (limits rom when slouched)
- weakness in rc m. and gh stabilizers (m. dont like to move when slouched position)
- clicking or popping sensation (associated w labrum tear)
how can you wrap an ant dislocation after rehab
to stop the apprehension position
labrum tears are commonly injured with what type of instability
gh
which lig attaches to the labrum
inf gh lig
what tendon attaches to the labrum and how does its mvt affect the labrum
biceps tendon
during eccentric cnt of the biceps to slow elbow down from extension, the tension pulls on the labrum
what is a bankart lesion and a reverse bankart
inj to ant labrum associated w ant sh instability ( 3 to 6 o’clock)
reverse bankart: post aspect of labrum
what is a SLAP lesion and what kind of mvt is it caused by
tear of the sup labrum ant to post (11 to 1 o’clock)
may involve bicep tendon
repetitive overhead mvt (ecc force on m. that pulls on its attachements)
what is a type 1 slap lesion
degenerative fraying of sup labrum near insertion of LHBT bicep tendon intact
what is a type 2 slap lesion
avulsion of glenoid labrum w associated tear of the LHBT
what is a type 3 slap lesion
bucket handle type tear of sup labrum w displacement of the fragment w bicep anchor intact
what is a type 4 slap lesion
bucket handle tear of sup labrum w extension into the bicep tendon, LHBT tear
which slap lesion types require sx
type 3 and 4
how to know if bicep is affected in slap lesion types
test mmt; will hurt and cause discomfort
common s/s of labral tears
pain w gh mvt
feeling of locking, clicking and clunking)
pain in biceps tendon (attachment to sup labrum)
limited rom
pain feels deep in sh (usually felt on ant aspect, if it feels superficial than must be an ac joint inj)
what do the rotator cuff m. do as a group
keep head of humerus a little inf and keep it in its socket (maintains head of humerus down when raise arms up to prevent impingement)
what is an impingement and what are the most common ones
decreased space where the rc tendons pass thru the coracoacromial arch
subacromial bursa rotator cuff (supraspinatus) long head of bicep
causes of impingement (4)
- irreg shaped acromion (some people have more hooked acromions that will decrease space)
- enlarged bursa (if more friction=swelling and less space)
- enlarged tendons (hypertrophy will decrease that space)
- loss of humeral head depression/stabilization (if no inf glide=less space)
- poor posture
- repetitive overhead mvt (if too much training too fast= m. could shut down)
- scapular dyskinesis (if scap doesnt move well when raise arms up= will hit top of glenoid fossa and reduce space)
- rc weakness
- gh instability (rotator cuff m. will fatigue)
common s/s of impingements
- pinching sensation w rom, especially overhead
- weakness in rc m. and/or biceps brachii (main cause for impingement)
- pain at common origin of rc or below ac joint
rotator cuff tendinopathy are caused by what type of contraction
eccentric cnt of rc m. (microtearing, larger tears- acute or due to micro tearing overtime)
RCT is subjected to more of micro or macro trauma
microtrauma
what kinds of tears can happen w RCT
partial (younger individuals), complete tears (30 +) and chronic tears (degeneration of tendons that can occur w aging over many years)
what are the intrinsic factors that can contribute to RCT
- m. imbalances (chest m. > back m.)
- m. weakness
- poor posture
- capsular laxity
- poor scap control (like impingement)
- impingement syndromes
what are the extrinsic factors that can contribute to RCT
- training errors (need proper strength to prevent inj)
- faulty technique (after time, can make other areas have to take in more load)
- incorrect surfaces and equipment (surface = lower body more and equipment = more upper body)
- poor environmental conditions (if ball slips, changing throwing pattern and throwing the m. off)
partial and complete tears of the RC can be what kind of thickness and are they more commonly associated w overuse or single episode traumas
partial thickness tears and full thickness tears (may develop from untreated partial thickness tears or secondary to a single force trauma)
overuse
common s/s of RCT
- weakness in RC m.
- poor posture
- moi or repetitive mvt (too much too fast or too much repetition)
- referred pain to deltoid tuberosity and/or lateral elbow
- pain w palpation of the common insertion of rc m.
- trigger points in the RC m. (when m. works too hard)
- pain w gh mvt (especially flexion, abd, external rotation)
what other conditions can result in subacromial bursitis
impingement and degenerative changes in RC m.
subacromial bursitis is common in what types of athletes and what other inj is it commonly mistaken w
common in OH athletes
RC pathology
s/s or subacromial bursitis
- point tenderness on ant and lateral edges of acromion process
- painful arc btw 70-120° of passive abd
- inability to sleep (affected side, active pain if inflamed even if not sleeping on it)
- pain referred to distal deltoid attachment
- pain on initiation and acceleration of throw (pain at beginning here and at the end for RCT)
what is the most common moi for a bicep tendinopathy
- repetitive overuse during rapid OH mvt (involving elbow flexion and supination activities)
- direct blow (transverse humeral ligament damage); inflammation of tendon bc of friction on bicipital groove)
- ant impingement may damage tendon
what sports are commonly associated w bicep tendinopathy
racquet sports, shot putters/javelin, baseball/softball, QB, swimmers
what is a bicep tendinopathy
irritation of the tendon as it slides within the bicipital groove
s/s bicep tendinopathy
- pain w flexion of sh and elbow
- pain w OH mvt
- pain in ant aspect of sh in the groove for bicep tendon (flipping in and out with ext and int rot)
- pain w palpation of the biceps tendon, coracoid process
what are the moi for a bicep strain/rupture
macro vs micro trauma
foosh
excessive resistance (gymnasts, swimmers, weight lifters)
prolongued tendinopathy
s/s of biceps tendon rupture
- snapping sensation
- intense pain
- ecchymosis
- palpable defect
- weakness in flexion of elbow and shoulder and supination of forearm
what moi causes a pec major strain
forceful eccentric contraction (tackle or weight lifting)
muscle contusions are caused by what moi, are common in what m. and what are the common s/s
direct trauma to m. belly
common in biceps, delts and triceps
presents w ecchymosis, swelling, limited ROM, weakness in MMT
what is thoracic outlet compression syndrome and what are the two types one can have
n. and/or vessels become compressed in proximal neck or axilla (bc of bad posture or not using the diaphragm properly)
neurological (90% of cases); lower trunk of brachial plexus
vascular ; subclavian a. and v. (refer right away)
s/s of thoracic outlet syndrome if vessels are compressed and if nerves are
vessels: subclavian v. (edema, stiffness in hand, cyanosis), subclavian a. (rapid onset of coolness, numbness in whole arm, fatigue after exertional OH activity, radial pulse maybe weak/absent w arm hyper extension)
nerves: aching; pins/needles sensation; numbness; weakness in gripping and atrophy of hand m.
long thoracic n. palsy (C5-7) are most common w which athletes, what kind of moi
spontaneous or traumatic
OH athletes more at risk
innervates the serratus anterior (keeps scap in rib cage; scap won’t be where its supposed to ability to grab w hand the inf and medial borders)
what joints will be affected following scapular dyskinesis
AC, GH and SC joints
what is scapular dyskinesis
abnormal scapular positioning and kinematics
Scapular malposition
Inferiomedial border prominence
Coracoid pain and malposition (felt during palpation)
dysKinesis of scapular motion (arms above heads, flex, abd, etc will hurt)
what is the normal static alignment of the scapula
- vertebral border of scap is // to spine and 3” from midline
- located btw 2nd and 7th rib
- scap is flat against thorax
- rotated 30° ant to the frontal plane
s/s of scapular dyskinesis
- pain in ant or posterior sup aspect of the shoulder
- pain in upper part of lat arm below acromion
- pain in upper fiber traps
- SICK acronym
- improper posture (flat back or round shoulders)
- fatigue w activity (m. aren’t working properly)
can you tape a misplaced scap
yes you can tape to bring the tilt backwards so the scap isn’t too much elevated
