Lecture 8 - Shoulder Injuries Flashcards
What is scapulohumeral rhythm?
- movement of the scapula relative to the movement of the humerus
- the scapula moves on the thorax so it can get to the final ranges of motion; scapula compensates the humerus
- normal ROM for shoulder abduction & flexion is 120 degrees
- 180° total from neutral to full abduction
- OVERALL — approximately 2 degrees of shoulder movement for every 1 degree of scapular movement
What is a sternoclavicular sprain?
- an injury to the joint where the clavicle meets the sternum
What is the MOI of a sternoclavicular sprain?
- FOOSH (Fall on outstretched hand)
- Traction force when the arm is at 90º abduction & then it is pulled forcefully into horizontal extension away from the body
What is a 1st degree sternoclavicular sprain?
- mild point tenderness, no displacement, minimal laxity, minimal loss of strength & function
What is a 2nd degree sternoclavicular sprain?
- partial tear of ligaments (sternoclavicular & costoclavicular), resulting in moderate displacement one bone higher than the other
- moderate tenderness, moderate laxity, moderate swelling, moderate loos of strength/function
What is a 3rd degree sternoclavicular sprain?
- a complete rupture (total displacement of sterno clavicular joint, usually superiorly & anteriorly)
- severe tenderness, laxity, loss of function/strength
What is the treatment for a sternoclavicular sprain?
- 1st & 2nd Degree - rest, ice, tubular sling support with the elbow at 45°, 3-10 days in sling (depends on severity)
- 3rd Degree - if unstable & neuro or vascular compromise is evident, then surgery is required
What is an Acromioclavicular sprain?
- also known as a shoulder separation,
- occurs when the ligaments connecting the clavicle to the scapula are stretched or torn
What is the MOI of an acromioclavicular sprain?
- FOOSH
- Direct blow with the point of the shoulder (ie. hitting the boards in hockey, landing on the shoulder in football)
- notice a deformity as the distal clavicle elevates & the humeral head drops inferiorly
What is a 1st degree AC sprain?
- a mild stretch of the ligament, causing mild tenderness over AC joint, Painful with horizontal adduction/flexion
What is a 2nd degree AC sprain?
- partial tear of the ligament causing moderate pain with mild superior displacement of clavicle evident on x-ray
What is a 3rd degree AC sprain?
- complete rupture of the ligament causing severe pain, moderate to severe displacement of clavicle superiorly
- X-ray not required for confirmation but used to rule out fracture
What is the treatment of an AC sprain?
- 1st & 2nd Degree - rest, pier, immobilization in a cuff & collar sling (1 week max). Continously; there after as needed in pain management
- 3rd Degree - same treatment as 2nd degree, the only consideration is whether to repair surgically or not
What is a Glenohumeral dislocation?
- when the head of the humerus is detached from the glenoid fossa
What is the MOI of a GH dislocation?
- FOOSH with arm externally rotated forcing the humeral head to displaces anteriorly & inferiorly
- direct blow to the hand or forearm when the shoulder is abducted to 90° & the elbow is bent (ie. As in a throwing motion). Humeral head is forced anteriorly & inferiorly
What are the signs of a GH dislocation?
- flattened deltoid
- humeral head palpable in the axilla
What tissues are damaged with a GH dislocation?
- Capsule, ligaments, tendon, labrum, blood vessels, nerves, potential fracture
What are the symptoms of a GH dislocation?
- Severe pain (initially)
- Numbness or parasthesia into arm or hand due to stretch &/or compression of the brachial plexus or axillary nerve
- Possible decreased radial pulse
What is the treatment of a GH dislocation?
- Do not attempt to reduce a first-time dislocation unless trained to do so
- Have the injured person hold their arm in the most comfortable position; splint & then take to hospital
What is a clavicular fracture?
- a break in the clavicle (collarbone)
- one of the most common fracture of the body
- Most common point of fracture is the mid 1/3 clavicle (80%) where it changes shape & direction creating a transition point & weakening the clavicle
What is the MOI of a clavicular fracture?
- Direct impact
- FOOSH
What are the signs of a clavicular fracture?
- Upward displacement of the medial clavicular segment due to pull of the SCM; with a falling forward of the same shoulder
What is the treatment of a clavicular fracture ?
- Reassure the athlete
- Provide splinting of the shoulder/arm in the most comfortable position, then transport to hospital
- At the hospital they usually immobilize the clavicle in a modified figure 8 splint
What is a humeral fracture?
- a break in the humerus
- These can occur on the proximal humerus or in the humerus shaft
What is the MOI of a humerus fracture?
- Generally from a direct blow
- May result from FOOSH
- This injury if often mistaken for deep contusion
What are 4 types of humeral fractures?
- shaft fracture
- surgical neck fracture
- supracondylar fracture
- epiphyseal fracture
What is a humeral shaft fracture?
- a fracture in the long portion (shaft) of the humerus
- can occur due to high-energy trauma in younger people or low-energy trauma in older individuals
- watch for hampered circulation, the brachial artery may be damaged as it runs right along the humerus
- Always check the radial pulse if a humeral fracture is suspected
What is a humeral surgical neck fracture?
- a break in the narrow part of the humerus just below the humeral head & above the shaft
- most frequent area of fracture
What is a humeral supracondylar fracture?
- a break in the distal part of the humerus, above the elbow joint
- common in children, especially those younger than 8 years old
- often results from FOOSH
What is a humeral Epiphyseal fracture?
- a fracture of the growth plate in the humerus
What is the treatment for humeral fractures?
- Reassure the athlete
- Place arm & shoulder in a sling & swath in the most comfortable position
- Transport to hospital
What is shoulder bursitis?
- inflammation of the subacromial or sub-deltoid bursa
What is the MOI of shoulder bursitis ?
- Direct trauma to the shoulder region
- Overuse repetitive abduction & overhead motions
- Classic Sign - Painful Arc: increased pain in shoulder abduction from approximately 80 - 120 degrees
- The bursa is being pinched between the humeral head & the Acromioclavicular arch
What is the treatment of shoulder bursitis?
- Rest from the insulting mechanism of overuse
- Correct any biomechanical causes (i.e., improper throwing mechanics)
- Anti-inflammatory modalities
- NSAIDS (non-steroidal anti-inflammatory drugs)
- Cortisone can be used for chronic conditions
What is biceps tendonitis ?
- inflammation of the biceps tendon
What is the MOI of biceps tendonitis?
- Overuse & improper mechanics of the shoulder
- Long head of the biceps becomes inflamed in the bicipital groove
What are signs & symptoms of biceps tendonitis?
- Increased pain through the shoulder, especially with flexion
- There will be a positive speeds test
What is the treatment of biceps tendonitis?
- rest, ice, ultrasound, galvanic currents, NSAIDS, reconditioning exercises
What is rotator cuff tendonitis?
- inflammation of the 4 muscles that make up the rotator cuff
What is the MOI of rotator cuff tendonitis?
- May be the result of acute trauma (i.e., FOOSH)
- Overuse & improper shoulder mechanisms (excessive internal/external motion in an abducted position) (I.e., throwing)
What are some sports rotator cuff injuries are seen in?
- Commonly seen in swimmers, volleyball, overhead pitching or throwing activities, tennis
What is the treatment of rotator cuff tendonitis?
- Rest, ice, galvanic currents, ultrasound, NSAIDS
- Proper conditioning involves adequate strength & endurance along with proper skill mechanics
- Important to keep the shoulder stabilizers in good balance
- Eccentric exercises must be emphasized
