Exam 3 Flashcards
Shoulder dislocations
Anterior
Posterior
Inferior
Superior
Glenohumeral Dislocations
- check for distal pulses and sensations
- splint in position found
- forced reduction can damage glenoid fossa, coracoid process, or neurovascular structures
Dermatomes
- Supraclavicular - C4
- lateral arm - C5
- medial arm - T1
- axial -T2
- axial to nipple - T3
- nipple - T4
Rotator cuff impingement symptoms
- Decreased space for RC tendons to pass below coracoacromial arch
- imflammation
Rotator cuff impingement causes
- Decreased space below subacromial arch (could be born that way)
- anatomical variation of subacromial arch
- restricted GH motion
- fatigue
- decreased strength of RH
- poor scapular biomechanics
Thoracic outlet syndrome
- caused by pressure on the trunks & medial cord of the brachial plexus, the subclavian artery, or the subclavian vein
Causes
- compression between the scalenes, between the clavicle & the ribs, and beneath the pectoralis minor
Clavicular fractures
- immobilize and transport to physician
- displaced fractures of medial 1/3 may require emergency surgery (neurovascular compromise)
4 major joints of the shoulder
- Glenohumeral joint (GH)
- Acromioclavicular joint (AC)
- Sternoclavicular joint (SC)
- Scapulothoracic articulation
AC joint sprains
Grade 1:
- partial damage of the AC ligament & capsule
- POP over AC joint; no laxity or deformity
Grade 2:
- rupture of Ac ligament & partial damage to CC ligament
- slight laxity & deformity of Ac joint; slight step deformity
Grade 3:
- complete tearing of AC & cc ligaments; possible involvement of deltoid & trapezius fascia
- obvious dislocation of distal end of clavicle from acromion process
Grade 4:
- clavicle posterior into insertion of upper trapezius
- being pushed upward
Grade 5:
- clavicular displacement 1-3 times height of contralateral clavicle
- .Big separation
Grade 6:
- clavicle displaced inferiorly under coracoid
- pushed forward under coracoid
Banker lesion
- difficult to identify clinically
Primary complaints - pain or sensation of instability as humoral head moves against the anterior labrum during GH joint play assessment, load & shift testing, or external rot of the humerus
Hill-Sachs Lesion
- Bony defect of the posterior humoral head
- rarely symptomatic
- may lead to early degeneration of the GH joint
Causes
- can occur as the humoral head shears over the glenoid rim
Piano Key Sign
- Occurs when the distal clavicle depresses & elevates during palpation
- indicates damage to the coracoclavicular ligament
SLAP lesion - symptoms
- Tension of LHBT (follow-through) - pulls labrum away from grenoid fossa
- compression & inferior traction
- pain between AC joint & coracoid process during overhead movements that is relieved by rest
- loss of throwing control & velocity
- symptoms are typically clinically inconsistent
Rotator cuff impingement (compression - primary)
• Irregularly shaped acromion
- coracoacromial ligament
- enlarged bursa
- thickened RC tendons
Rotator cuff impingement (compression - secondary)
- Loss of humoral head depression/ stabilization
- poor posture
- repetitive overhead movement
Rotator cuff impingement (tensile - primary)
- Repetitive overload
- eccentric force
Rotator cuff impingement (tensile - secondary)
- Scapular dyskinesia
- RC muscle weakness
- GH instability
Slap lesion
- Superior labrum anterior to posterior
- Tears to the superior aspect of labrum that extend over & past to biceps insertion
