1. Apprehension Test 2. Sulcus Sign 3. Clunk Test 4. Anterior/Posterior Drawer Test 5. Relocation Test (Fowler or Jobe) 6. Feagin Test (Inferior Drawer Test)

Injuries to the Shoulder Complex Flashcards by Arizay Juarez

Anteriorly directed force or Direct blow;
Falling on an outstretched arm;
Displacement usually upward and anterior.

SC Joint Sprain

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Pain
point tender
disability
no joint deformity

Grade I SC Joint Sprain

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Pain
Point tender
pain with abduction and bringing arm across the chest (horizontal adduction)
Visible deformity

Grade II SC Joint Sprain

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pain;
point tender;
disability
swelling;
Gross deformity;

Grade III SC Joint Sprain

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PRICEMM;
immobilize;
x-ray;
refer to MD

SC Joint Sprain TX

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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

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SC joint stands for

Sternoclavicular Joint

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“Separated shoulder”

very common in sports

AC Joint Sprain DEF

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AC stands for

Acromioclavicular Joint

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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

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Mild stretch of AC ligament;
pain;
point tender;
swelling,
discomfort during movement;
no joint deformity

Grade I AC Joint Sprain

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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

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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

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PRICEMM;
immobilize;
x-rays;
refer to MD (conservative versus surgery approach)

AC Joint Sprain TX

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3 DIAG tests for AC Joint Sprain

Piano Key Sign
Shear Test
Compression Test

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“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

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direct blow;
indirect force with arm abducted and externally rotated

Anterior dislocation of GH Joint MOI

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direct blow; falling on an outstretched arm that is internally rotated

Posterior dislocation of GH Joint MOI

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Pain;
obvious deformity (if still out);
loss of function;
swelling

S/S of GH Joint

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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

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may recover with proper rehab after first time but may require surgery once they become recurrent.

GH Joint Anterior Dislocation TX

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surgery often required after first episode

GH Joint posterior
Dislocation TX

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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)

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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)

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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

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