Conditions Of The Shoulder Flashcards by Alysha Yearwood

GH joint sprain MOI

Arm is forcibly abducted (GH external rotated)

- anterior capsule & GH ligament causing numeral head to ‘slip out’ of glenoid fossa

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What are the 4 joints of the shoulder?

Sternoclavicular
Acromioclavicular
Glenohumeral
Scapula thoracic

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GH joint sprain S&Sx

Pain in anterior GH
Pain w/ reproduced MOI (abd&ext rot)
Joint laxity
Pain, swelling, & decreased ROM

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GH joint sprain management

PIER
Immobilization 12-24 hrs
Pain free ROM
Delay external rotation & abduction for 3 weeks, allow capsule to heal

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Anterior Instability MOI

Blow to post-lateral aspect, forces head of humerus anteriorly in relation to glenoid fossa
Abduction, external rotation & extension

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Anterior Instability S&Sx

Failure of MGHL, IGHL
Head of humerus lies adjacent to coracoid process
Humerus slides ant. IGHL avulsed from ant. Lip of labrum (Bankart Lesion)

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Posterior Instability MOI

Occurs when humerus is flexed & int rotated w/ post forces directed along long axis of humerus

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Inferior Instability MOI

Rare

Primary restraint to motion in superior GH ligament

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Multidirectional Instability MOI

Damage takes place in more than one plane

Normally ant/post dislocations are associated w/pre-existing inferior laxity or laxity in opposite direction

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Multidirectional Instability S&Sx

Pain/clicking w/ simple tasks

Need to identify multidirectional instability to address all areas of weakness

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Multidirectional Instability Management

Conservative

Surgery for those who do not respond to conservative Rx

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Sternoclavicular Joint Sprain MOI

Compression related to a direct blow
-individual side lying & player falls on top
Indirect force due to FOOSH
- anterior displacement

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Sternoclavicular Joint Sprain S&Sx

G1: TOP w/no visible deformity
G2: joint subluxation (bruising, swelling & pain/ pain w/ cross-flexion, joint compression
G3: prominent displacement, may involve #, unable to perform scapular protraction, numbness, tingling due to compression of thoracic inlet

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Sternoclavicular Joint Sprain Management

G1: PIER, sling (1-2 weeks)
G2: longer immobilization (3-6 weeks) - sling/ figure 8 brace
G3: immediate reduction by MD, immobilization,

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AC joint Sprain MOI

Fall on tip of acromion, fall transmitted along axis of humerus w/lumbar adduction

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AC joint sprain Sx

G1: no disruption of AC/CCL min swelling, pain past 90* abduction
G2: AC ligament, CCL rupture, clavicle rides above level of acromion, minor step/gap at joint line, pain increases
G3: rupture of AC joint ligament, CCL & tearing of deltoid fascia, may involve neurological Sx

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AC Joint Sprain Management

G1&2: PIER, sling (1-3 weeks), RTP: Pad/tape to prevent further injury, Approximate ends of injury w/ pressure & compression
G2+: May be managed both operatively & non
G3: Surgery w/immobilization 4-6 weeks, strengthening (pre-surgery)

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Acute Dislocations MOI

May be associated w/# or nerve damage, may require EAP to be activated

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Acute Dislocations S&Sx

Intense pain,
Tingling/numbness
Prominent acromion, humeral head palpated in axilla 
Arm held at 20-30* abduct (ant disloc)
Arm held in full adduct (post disloc)
Ant delt is flat (post disloc)

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Acute Dislocations Management

1st time disloc = immediate referral
Treat as a # & splint in position of comfort
PIER unless neurological components affected

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What is Hill Sachs Leision

Small defect found in humeral head after ant disloc
Caused by impact of humeral head on glenoid fossa
Rarely symptomatic may lead to degeneration of joint

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How do you test for an Acute dislocation?

Apprehension test
Posterior apprehension
Sulcus Sign

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Chronic Dislocations MOI

Ant disloc, intracapsular
Same MOI as acute
As # increase force needed to produce injury decrease

Chronic Dislocations S&Sx

Pain, crepitation, clicking as arm shifts back to appropriate position,
Individual voluntary decreases disloc

Chronic Dislocations Management

If injury does not reduce, sling & swathe, PIER & refer Restore normal motion w/ strengthening Surgery may be warranted if instability persists

Glenoid Labrum Tears MOI

Tearing of labrum & IGHL (Bankart) Associated with trauma & ant instability Injury to superior labrum Disrupts LH biceps (SLAP) lesion

Glenoid Labrum Tears S&Sx

Pain, weakness when arm is over head (abd& external rotation) Results of disloc/subluxation

Glenoid Labrum Tears Management

Conservative Rx, rest, NSAIDs | Surgery may be warranted if individual doesnt respond

How does bursitis of the shoulder occur

Works w/ impingement syndrome | Usually subacromial bursa-impinged w/ over head activities

Bursitis S&Sx

Sudden shoulder pain w/ initiation, acceleration of throwing motion Pt. tenderness ant & lateral edges of acromion Painful arc Pain referred to distal deltoid attachment

Bursitis Management

Acute care protocol R/O other conditions Find cause,treat cause

What Special test can you perform to test for Bursitis of the shoulder?

``` Hawkins Kennedy (supraspinatus/biceps) Drop Arm (supraspinatus) empty Can (supraspinatus) ```

Bicipital Tendonopathy MOI

Repetitive overuse during rapid motion involving elbow flexion & supination Irritation occurs as tendon moves in Bicipital groove

Bicipital Tendonopathy S&Sx

TOP Bicipital groove | +ve yergasons & speeds test

Bicipital Tendonopathy Management

Restriction of rotational activities Due to potential vascular impingement when arm is fully addicted, slightly abducted in sling if immobilized PIER, modalities

Traumatic Clavicular # MOI

Frequently occur in middle 1/3 of clavicle (where it changes direction)

Traumatic Clavicular # S&Sx

Swelling, ecchymosis deformity | Pain w/GH movement

Traumatic Clavicular # Management

Immobilization in cling & swathe | Following Ax by GP, figure 8 brace

Scapular # MOI

Avulsion # of coracoid | Direct contact

Scapular # S&Sx

Minimal displacement, localized hemorrhage Individual reluctant to abduct GH Pain R/O underlying pulmonary injury

Scapular # Management

Immobilize in sling & swathe | Refer to MD

Epiphyseal & Avulsion # MOI

Epiphyseal centres at shoulder remain unfused longer period of time Prox humeral epiphysis close at 18-21 Little league shoulder to repetitive med. rot. & adduction Avulsion to coracoid process w/young adults w/repetitive forceful throwing

Epiphyseal & Avulsion # S&Sx

Acute shoulder pain when attempting to throw hard Pain w/deep palpating in axilla Avulsion #, pain w/palpating at site

Epiphyseal & Avulsion # Management

Immobilize in sling & swathe | PIER

Torticollis MOI

Scoliosis of c-spine, SCM Deformity in which head tilts toward one shoulder & chin rotates toward opposite shoulder "Wry neck" result of muscular strain following exposure to cold/sleeping w/neck in abnormal position

Torticollis S&Sx

Abnormal neck position

Torticollis Management

Usually resolves spontaneously in 2 weeks | Modalities & ROM

C-spine Sprain MOI

Extreme motion or violent muscle contraction | Maintaining head in one position, may also produce sprain

C-spine Sprain S&Sx

Pain Stiffness No neuro

C-spine Sprain Management

Modalities | Limiting ROM

C-spine Strain MOI

Usually involves SCM/upper traps May also involve scalenes, levator scap Same MOI as sprain

C-spine Strain S&Sx

Pain Stiffness Restricted ROM Muscle spasm

C-spine Strain Management

Modalities C-collar Strengthening

Throacic Outlet Compression Syndrome Etiology

Nerves &/or vessels become compressed in proximal neck/axilla I. 2 forms: 1) Neurological - stretch or compression of nerve 2) Vascular - Impingement of subclavian artery/vein

Throacic Outlet Compression Syndrome S&Sx

Nerve- aching pain, pins & needles/numbness, weakness Vascular - blockage of subclavian vein (Edema/stiff hand) - occlusion of artery (rapid onset, coldness/numbness arm, fatigue)

Throacic Outlet Compression Syndrome Management

Conservative Rx - Ax muscle strengthening & posture