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