Injuries to the Shoulder Complex Flashcards
Anteriorly directed force or Direct blow;
Falling on an outstretched arm;
Displacement usually upward and anterior.
SC Joint Sprain
Pain
point tender
disability
no joint deformity
Grade I SC Joint Sprain
Pain
Point tender
pain with abduction and bringing arm across the chest (horizontal adduction)
Visible deformity
Grade II SC Joint Sprain
pain;
point tender;
disability
swelling;
Gross deformity;
Grade III SC Joint Sprain
PRICEMM;
immobilize;
x-ray;
refer to MD
SC Joint Sprain TX
Relatively rare injury with the displacement usually being upward and anterior.
If you have a posterior displacement, there are concerns with vascular or respiratory impairment.
SC Joint Sprain
SC joint stands for
Sternoclavicular Joint
“Separated shoulder”
very common in sports
AC Joint Sprain DEF
AC stands for
Acromioclavicular Joint
Direct blow to the tip of the shoulder
falling on an outstretched arm causing an upward force along the long axis of the humerus
i.e. Romo & Garoppolo
AC Joint Sprain MOI
Mild stretch of AC ligament;
pain;
point tender;
swelling,
discomfort during movement;
no joint deformity
Grade I AC Joint Sprain
Rupture of the superior/inferior AC ligaments
Stretch of CC ligaments;
pain;
pain with abduction and horizontal adduction
point tender;
swelling;
some deformity;
Grade II AC Joint Sprain
Rupture both AC and CC ligaments;
gross deformity with prominence of outer clavicular head; pain;
point tender;
loss of movement;
instability
Grade III AC Joint Sprain
PRICEMM;
immobilize;
x-rays;
refer to MD (conservative versus surgery approach)
AC Joint Sprain TX
3 DIAG tests for AC Joint Sprain
Piano Key Sign
Shear Test
Compression Test
“Dislocated Shoulder;”
accounts for up to 50% of all dislocations;
85%-90% will reoccur when caused by direct trauma;
anterior dislocation are the most common although posterior and inferior dislocations occur.
GH Joint DEF
direct blow;
indirect force with arm abducted and externally rotated
Anterior dislocation of GH Joint MOI
direct blow; falling on an outstretched arm that is internally rotated
Posterior dislocation of GH Joint MOI
Pain;
obvious deformity (if still out);
loss of function;
swelling
S/S of GH Joint
Check distal pulse and circulation;
PRICEMM;
immobilization;
refer to MD (possible reduction)
Anterior dislocations: may recover with proper rehab after first time but may require surgery once they become recurrent.
Posterior dislocations: surgery often required after first episode
GH Joint TX
may recover with proper rehab after first time but may require surgery once they become recurrent.
GH Joint Anterior Dislocation TX
surgery often required after first episode
GH Joint posterior
Dislocation TX
6 DIAG of GH Joint
- Apprehension Test
- Sulcus Sign
- Clunk Test
- Anterior/Posterior Drawer Test
- Relocation Test (Fowler or Jobe)
- Feagin Test (Inferior Drawer Test)
6 Associated Conditions of GH Joint
- Vascular injury Brachial plexus injury
- Capsular injury
- Glenoid labrum tear (Bankhart lesion; SLAPlesion)
- Rotator cuff tear or
- avulsion fracture
- Fractures (Hill-Sacks lesion)
Affects the subdeltoid or the subacromial bursa**
Bursitis DEF
Overuse; direct blow
bursitis moi
Pain; point tender;
loss of function;
weakness;
aching pain at rest
bursitis s/s
PRICEMM;
NSAID’s
bursitis tx
Bursitis DIAG Test
Apley’s Scratch Test
Most often involves the supraspinatus
Rotator Cuff Strains
Acute (single trauma) or repetitive trauma
most often associated with overhead throwing
Rotator Cuff Strain MOI
Pain that increases with activity;
point tender;
loss of function;
loss of ROM;
pain on abduction, ER, and flexion of the shoulder;
loss of strength;
possibly radiating pain
Rotator Cuff Strain S/S
PRICEMM;
refer to MD;
appropriate rehab;
gradual return back into activity;
possible surgery
Rotator Cuff Strain TX
2 Rotator Cuff Strain DIAG Test
Drop Arm test
Empty Can test
Impingement Syndrome Point 1
Injuries involving the soft tissue comprising the subacromial space
supraspinatus
biceps tendons
subacromial bursa
Impingement Syndrome is caused by
a repetitive use of the arm above the horizontal level
(overuse)
Impingement Syndrome produces a
progressive degenerative change
Impingment Syndrome often begins as
tendinitis (esp. suprapinatus)
Produces edema and hemorrhage
Stage 1 of Impingement Syndrome
Thickening and fibrosis (shortening) of soft tissue
Stage 2 of impingement Syndrome
Muscle defect of less than 1 centimeter and possible partial muscle tear
Stage 3 of impingement Syndrome
Muscle defect of more than 1 centimeter and possible degeneration of the clavicle
Stage 4 of impingement Syndrome
Pain is biggest symptom (initially a dull ache that progresses to discomfort during activity)
Impingement Syndrome
Pain is biggest symptom (initially a dull ache that progresses to discomfort during activity)
Impingement Syndrome
less than 25 impingement syndrome
athletes
25-40 impingement syndrome
weekend athletes
over the age of 40 impingement syndrome
workers
Impingement Syndrome prevention includes
proper coaching
stretching and strengthening
Impingement Syndrome Management includes:
PRICEMM initially with appropriate rehab.
May require surgery in later stages
High School Pitch Count (Grades 9 through 12):
0-30 pitches
0 rest days
High School Pitch Count
31-45 pitches
1 rest day
High School Pitch Count
46-65 pitches
2 rest days
High School Pitch Count
66-85 pitches
3 rest days
High School Pitch Count
86-110 pitches
4 rest days
0-20 pitches 0 days rest
21- 35 pitches 1 day rest
36 - 50 pitches 2 days rest
51 – 65 pitches 3 days rest
66 - 85 pitches 4 days rest
Junior High Pitch Count (Grade 7&8)
Impingement Syndrome 3 DIAG
Active Impingement
Neer’s Sign
Hawkins (Hawkins-Kennedy)
subacromial impingement DIAG
Neer’s Sign
tests for supraspinatus tendon impingement
Hawkins (Hawkins-Kennedy)
Overuse injuries are common in those who perform repetitive overhead activities.
Injuries will vary according to which phase they occur in (cocking, acceleration, or deceleration phase)
Throwing Injuries
Anterior shoulder pain due to a strain or inflammation to any of the internal rotators
cocking phase of throwing injuries
Strain or inflammation of internal rotators
Synovitis of the SC or AC joint
“Little Leaguer’s Shoulder:” stress fracture to the proximal humeral epiphysis
Spontaneous fractures of the proximal humerus
Acceleration phase of throwing injuries
stress fracture to the proximal humeral epiphysis
occurs in the acceleration phase of throwing injuries
“Little Leaguer’s Shoulder:”
Impingement syndrome
Rotator cuff strains
deceleration phase of throwing injuries
“Winging of the scapula”
Long thoracic nerve injury
long thoracic nerve injury results in general weakness of what muscle
serratus anterior muscle
which is worse bilateral or unilateral long thoracic nerve injury
unilateral
Long Thoracic Nerve Injury moi
Indirect or direct trauma; overuse
Protrusion of the scapula posteriorly
Long thoracic nerve injury s/s
Long Thoracic nerve injury DIAG
Scapular protraction test
“Burner or stinger”
Brachial Plexus Injury
Forced lateral flexion of the neck with the opposite shoulder depressed
Brachial Plexus Injury MOI
Transitory paralysis of arm with a numbing or tingling sensation
Brachial Plexus Injury S/S
TX of brachial plexus injury s/s
PRICEMM
Brachial Plexus Injury DIAG
Spurling’s maneuver
% of clavicle fracture that occur in the middle
80%
15% of clavicle injuries occur in outer third
15%
% of clavicle injuries occur inner third of clavicle
major issues esp. if backwards
5%
Direct blow; falling on an outstretched arm (Romo)
Clavicle Fracture MOI
Pain;
point tender;
loss of function;
deformity;
localized swelling
Clavicle Fracture s/s
Immobilize; ice; refer to MD
Clavicle Fracture TX
Rare injury in sports
Scapular Fractures
Direct blow; fall on an outstretched arm; direct trauma
Scapular Fracture MOI
Pain;
point tender;
loss of function;
possible deformity;
swelling;
holds arm to the side
Scapular Fracture S/S
Immobilize; ice; refer to MD
Scapular Fracture TX
Upper arm contusions involve what 3 muscles
biceps
deltoid
triceps
What nerve is affected by upper arm contusions resulting in temporary paralysis
radial nerve
Treat like any other bruise but be aware of the possible development of myositis ossificans
upper arm contusions
Irritation of biceps tendon in the bicipital groove
Bicipital Tendonitis DEF
Overuse activity (throwing motion)
Bicipital Tendonitis MOI
Pain; point tender; loss of function; swelling; inflammation
S/S of Bicipital Tendonitis
PRICEMM; NSAID’s; strengthening
TX of Bicipital Tendonitis
Bicipital Tendonitis DIAG
Speed’s Test
Degeneration or tear of transverse ligament that holds the long head of the biceps tendon in place
Subluxation of Biceps Tendon DEF
Chronic biceps tendinitis; acute tear
Subluxation of Biceps Tendon MOI
Pain; point tender; snapping sensation
Subluxation of Biceps Tendon S/S
PRICEMM; refer to MD for possible surgery
Subluxation of Biceps Tendon TX
Subluxation of Biceps Tendon DIAG
Yergason test
Degeneration or violent contraction against firm resistance; Strong contraction
Biceps Brachii Rupture MOI
Pain; point tender; protruding bulge (long head);
loss of strength
Biceps Brachii Rupture S/S
PRICEMM; refer to MD
Biceps Brachii Rupture TX
Biceps Brachii Rupture DIAG
Ludington’s test (long head)
Direct blow; indirect trauma; falling on an outstretched hand
Humerus MOI
Sudden pain; point tender; loss of function; deformity
humerus fracture s/s
Immobilize;
refer to MD
(radial nerve resulting in wrist drop or inability to perform supination)
humerus fracture TX
labrum is intact but evidence of fraying/degeneration
SLAP Lesion of GH Joint Type 1
Detachment of superior labrum & long head of tendon of biceps from glenoid rim
SLAP Lesion of GH Joint Type 2
Superior Labrum torn & long head tendon intact
SLAP Lesion of GH Joint Type 3
Tear in superior labrum & long head tendon intact
SLAP Lesion of GH Joint Type 4
JH pitch count (7&8)
0-20 pitches
0 days rest
JH pitch count
21- 35 pitches
1 day rest
JH pitch count
36 - 50 pitches
2-day rest
JH pitch count
51 – 65 pitches
3 days rest
JH pitch count
66 - 85 pitches
4 days rest
Big phase
large muscles are dominating the muscles in the back
Deceleration phase of throwing injuries
