Hip and Shoulder Flashcards
Quadriceps contusions
Cause: constant exposed to traumatic blows
Signs: pain, loss of function, bleeding in affected muscles
Care: RICE, NSAIDS, crutches for severe cases, isometric quad contractions as soon as tolerated
Myositis Ossifications
Cause: formation of ectopic bone following repeated blunt force trauma
Signs: x-rays show calcium deposis; pain, weakness, swelling, decreased ROM, tissue tention and point tenderness
Care: conservative treatment, surgery if too painful and restricting of ROM
Quadriceps muscle strain
Cause: sudden stretch when falling on bent knee or sudden contraction; associated w/ weakend or over constricted muscle
Signs: peripheral tear causes fewer symptoms than deeper tear; pain, point tenderness, spasm, loss of function, discoloration
Care: fit for crutches; rest, ice, compression; determine extent of injury early; neoprene sleeve to provide support
Hamstring muscle strains
Cause: hamstring/quad contract together; change in role from hip extender to knee flexor; fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances
Signs: muscle belly or point of attatchmet pain; capillary hemorrhage, pain, loss of function, discoloration
Grade 1: soreness during movement and point tenderness
Grade 2: partial tear, identified by snap or tear, severe pain, loss of function
Grade 3: rupturing of tendinous or muscular tissure
Care: RICE, restrict activity, avoid ballistic stretching/explosive sprinting initially; fit for crutches
Groin strain
Cause: difficult to diagnose; early in season due to poor strength/flexibility; from running, jumping, twisting w/ hip external rotation or sever
Signs: sudden twinge or tearing during active movement, produce pain, weakness, and internal hemorrhaging
Care: RICE, NSAID, determine muscle(s) involved, rest, refer out if extreme, fit for crutches if necessary
Hip Joint sprains
Cause: result of violent twist due to forceful contact, force form opponent/object or trunk forced over planted foot in opposite direction
Signs: inability to circumduct hip, pain in hip region, w/ hip rotation increasing pain
Care: x-rays/MRI should be ruled out, RICE, NSAIDS and anlgesics, crutches based on severity,
Piriformis Syndrome
Cause: compression of sciatic nerve; irritation due to tightness/spasm of muscle; may mimic sciatica
Signs: pain, numbness and tingling in butt- may extend below knee into foot; pain increases following periods of sitting, climbing stairs, walking, or running
Care: stretching, massae, NSAIDS, cessation of aggrivating activities, corticosteroid injections, surgery (possibly)
Legg Calve’-Perthes Disease
Cause: avascular necrosis of the femoral head in children 4-10; articular cartilage becomes necrotic and flattens
Signs: pain in groin referred to abdomen/knee; limping; varying onsets and exhibited limited ROM
Care: bed rest to reduce chronic condition, brace to avoid weight bearing, early treatment may reossify and revascularize
Complication: if not treated, will result in ill-shaping and osteoarthritis in later life
Slipped Capital Femoral Epiphysis
Cause: may be growth hormone related, 25% of cases seen in both hips, epiphysis slips from femoral head in backwards direction due to weakened growth plate, may occure during elevated growth
Signs: pain in groin, hip and knee pain during passive and active motion, limitations of abduction, flexion, medial rotation, and a limp
Management: w/ minor slippage, rest and non-weight bearing may prevent further slippage, major displacement requires surgery, if undetected or surgery fails- severe problems result
Iliac Crest Contusion (hip pointer)
Cause: contusion of iliac crest or abdominal musculature; result of direct blow
Signs: pain, spasm, & transitory paralysis of soft structures; decreased rotation of trunk or thigh/hip flexion due to pain
Care: RICE for at least 48 hrs, NSAIDS; bed rest 1-2 days; refer out for x-rays, padding work to minimize chance of added injury
Avulsion Fractures
Cause: avulsions seen in sports w/ sudden accelerations/decelerations; pulling of tendon away and off bony insertion; common sites include ASIS (sartorius) AIIS (rectus femoris attachment) ishical tuberosity (hamstring)
Signs: sudden localized pain w/ limited movement; pain, swelling, point tenderness
Care: rest, limited activity and graduated exercise
Sternoclavicular Joint (SC Joint)
between sternum and clavicle
allows for rotation during shrugs and reaching above the head
Supported by 4 Ligaments: anterior and posterior SC ligament, costoclavicular ligament, interclavicular ligament
Acromioclavicular Joint (AC Joint)
between acromion process and clavicle
limited motion
supported Primarily by AC ligament
Secondarily by coracoacromial and coracoclavicular ligaments
Glenohumeral Joint (GH Joint)
“true” shoulder joint
Glenoid Fossa of the scapula -VERY shallow
head of the humerus (3-4 x larger than glenoid)
Lacking in boney stability
deepened by miniscus structure - Glenoid Labrum: adds stability to joint
Stabilized by two types of stabilizers:
1) Static: joint capsule and several GH ligaments
2) Dynamic: supraspinatus, infraspinatus, teres minor, subscapularis
Bursa of the shoulder
subacronial (clinically most important)
Nerve supply of the shoulder
Brachial Plexus (c5-t1)
Blood supply of shoulder
subclavian and axillary artery
Shoulder Flexion
Anterior Deltoid and Pectoralis Major
Shoulder Extension
Posterior Deltoid
Shoulder Abduction
Supraspinatus and Middle Deltoid
Shoulder Adduction
Pectoralis Major and Latissimus Dorsi
Shoulder Internal Rotation
Anterior Deltoid and Subscapularis
Shoulder External Rotation
Infraspinatus and Teres Minor
Shoulder Horizontal Adduction/Flexion
Anterior Deltoid
Shoulder Horizontal Abduction/Extension
Posterior Deltoid
Scapula Movements
Elevation, Depression, Protraction, and Retraction
Throwing Motion: Windup/Cocking Phase
shoulders abduct, externally rotate, and horizontally abduct
Throwing Motion: Acceleration Phase
Max external rotation until ball release
Humerus adducts, horizontally adducts, internally rotates
Scapula elevates and abducts, rotates upward
Throwing Motion: Deceleration Phase
Ball release until max shoulder internal rotation
Eccentric contraction of external rotators to decelerate humerus while rhomboids decelerate scapula
Clavicular Fractures
Cause: FOOSH, fall on tip of shoulder or direct impact; primarily in middle third, greenstick fracture occurs in young athletes
Signs: supporting of arm, head, tilted towards injured side w/ chin turned away; clavicle may appear lower; palpation reveals pain, swelling, deformity, and point tenderness
Care: Closed reduction- sling and swathe, immobilize w/ figure 8 brace 6-8 weeks, removal of brace followed by mobes, isometrics, and sling for 3-4 weeks
Sternoclavicular Sprain
Cause: indirect force, blunt trauma (may cause displacement)
Signs: Grade 1: pain and slight disability
Grade 2: pain, subluxation w/ deformity, swelling and point tenderness w/ decreased ROM
Grade 3: Gross deformity (dislocation) pain, swelling, decreased ROM
Care: PRICE, immobilization (3-5 weeks) followed by graded reconditioning
Acromioclavicular Sprain
Cause: direct blow (from any direction) upward force from humerus, FOOSH
Signs: Grade 1: point tenderness and pain w/ movement; no disruption of AC joint
Grade 2: tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM (abd/add)
Grade 3: Rupture of AC and CC ligaments w/ dislocation of clavicle; gross deformity (step deformity); + Piano Key Test, pain, loss of function, and instability
Care: ice, stabilization, referral to physician
aggressive rehab required with all grades
Glenohumeral Dislocations
Cause: Head of humerus forced out of joint; anterior dislocation is result of anterior force on shoulder, forced abduction, extension, and external rotation; occasionally dislocation will occur inferiorly (Hill-Sachs Lesion vs Bankart Lesion vs SLAP tear)
Signs: flattened deltoid, prominent humeral head in axilla; arm carried in slight abduction/external rotation; moderate/severe pain and disability
Care: RICE, immobilization and reduction by physician
Hill-Sachs Lesion
Damage to the humeral head seen via x-ray
can be associated with shoulder dislocation
Bankart Lesion
Inferior labral tear
can be associated with shoulder dislocation
SLAP Tears
Superior Labrum Anterior to Posterior tear
Shoulder Impingement Syndrome
Cause: mechanical compression of supraspinatus tendon, glenoid labrum, subacromial bursa, and long head of biceps tendon due to decreased space under coracoacromial ligament
Signs: Diffuse pain, pain on palpation of subacromial space; decreased strength of external rotators compared to internal rotators; tightness in posterior and inferior capsule; positive Neer and Hawkins Kennedy test
Care: restore normal biomechanics to maintain space, strengthening of rotator cuff and scapula stabilizing muscles; stretching of posterior and inferior joint capsule
Rotator Cuff Tear
involves supraspinatus or rupture of other rotator cuff tendons; occurs near insertion on greater tuberosity; full thickness tears usually occur in athletes w/ history of impingement/instability
Signs: present w/ pain w/ muscle contraction; tenderness on palpation and loss of strength due to pain; loss of function, swelling; complete tear- empty can and impingement tests show + signs
Care: RICE, progressive strengthening of rotator cuff
Shoulder Bursitis
Etiology: chronic inflammatory condition due to trauma or overuse- subacromial bursa; may develop from direct impact or fall on tip of shoulder
Signs: pain w/ motion and tenderness during palpation in subacronial space; positive impingement tests
Management/Care: cold packs and NSAIDs to reduce inflammation
Bicipital Tendonitis
Cause: repetitive overhead athletes- balistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath
Signs: tenderness over bicipital groove, swelling, crepitus due to inflammation; pain when performing overhead activities; pain w/ Yerguson’s test
Care: rest and ice for inflammation, NSAIDs, gradual program of strengthening and stretching
Prevention of Thigh Injuries
Thigh must have maximum strength, endurance, and extensibility to withstand strain
dynamic stretching programs may aid in muscle preparation for activity
Strengthening programs can also help in preventing injuries; squats, lunges, leg press, core strengthening
Prevention of Shoulder Injuries
proper physical conditioning, develop body and specific regions relative to sport, warm-up should be used before explosive arm movements are attempted, contact and collision sport athletes should receive proper instruction on falling, protective equipment, mechanics versus overuse injuries
