lecture 9- shoulder Flashcards
Deep stabilizers (or rotator cuff: SSIT on humeral head)
-Supraspinatus; initiates abduction
-Subscapularis; internal rotation
-Infraspinatus; external rotation
-Teres minor; external rotation, adduction
Bursae shoulder
Subdeltoid and subacromial
shoulder injury mechanisms
Throwing, direct blow, resisting a force (especially in abd/ER), fall on outstretched arm (FOOSH)
Frozen shoulder=
capsule tightens up, gradually ‘thaws’ on its own, don’t know why, no real treatment, common in older females
Shoulder Contusion
Hx: direct blow
SSx: pain, tenderness, reduced ROM, bruising, swelling
Tx: POLICE, early ROM, no massage, or heat!!!!
shoulder Strain
Injury to muscles or tendon
Hx: resisting a force, pain worse when using muscles
SSx: pain, worse with active movement, reduced ROM, point tenderness (bruising)
Tx: POLICE, early ROM, NSAIDs, tape, physio and rehab
–> 3rd degree strains may need surgery
Tendonitis (Tendinopathy)
Hx: acute strain, overuse, impingement (ex. swimming)
SSx: acute strain but prolonged duration (imaging xray/diagnostic ultrasound)
Tx: NSAID /corticosteroid injection (not recommended anymore!!!), ROM, rest, physio, rehab, surgery?
Impingement= pinched nerves
(intrinsic and extrinsic)
- Intrinsic (primary) impingement
= something within the subacromial space is decreasing the space that is there.
Risk factor: if subacromial space is less than 7mm (bony formation - Extrinsic (dynamic instability)
= something is functionally wrong with the shoulder that is allowing it to go in positions that may cause impingement
treatment= getting people to “set their shoulders/retract scapulae”, to prevent tissues from getting caught on each other during shoulder flexion for example
Bursitits
Hx: acute trauma or overuse
SSx: aching pain, tenderness, reduced ROM (abd), may lead to frozen shoulder
Tx: same as tendinopathy
Sternoclavicular sprain (SC)
Hx: direct blow, torsion, fall
1st deg:
SSx= pain, tenderness, no deformity
Tx= rest, ice, NSAID, rehab
2nd deg:
SSx=as above plus deformity, crepitus, bruising, reduced shoulder ROM
Tx= sling (4-6 weeks), ROM, NSAID, physio, rehab
3rd deg:
SSx= as above plus marked deformity
Tx= as above but first sling, stabilize, hospital
Tends to recur easily
**2nd and 3rd degree send to hospital for imaging!!!! If clavicle is displaced posteriorly, it may out pressure on blood vessels, esophagus or trachea!!!
Acromioclavicular sprain (AC)
Hx: direct blow, fall
1st deg:
SSx= pain, worse on movement, point tenderness, swelling, mild deformity
Tx= POLICE, sling, ROM, physio
2nd deg (rupture of AC ligament):
SSx= as above plus more deformity, crepitus?, marked restriction in ROM
Tx= ice, sling, to hospital for xray, NSAID, physio, rehab
3rd deg (rupture of AC and CC):
SSx= marked deformity (step defect), pain etc.
Tx= as above, surgery?
Glenohumeral sprain (GH)
Hx: resisting a force (Abd, ER), fall, throwing
SSx= same as rotator cuff strain but pain is marked both on active AND passive movement
Tx= POLICE, sling, early ROM, NSAID, physio
**Note: 3rd deg GH sprain= glenohumeral dislocation
Glenohumeral dislocation
Hx: same as GH sprain
–> Forward (anterior, subcoracoid) (much more common)
SSx= humeral head palpable in axilla, deltoid flat, indented, arm in abduction, severe pain, reduced ROM
Tx= check neurovascular status! NPO, sling, to hospital (xray), reduction, surgery if recurrent!
Brace limits the movement
–> Downward (posterior, subglenoid)
SSx= same, except arm seems longer
Tx= same
recurrence is common!!!
Glenohumeral dislocation management
- Immediate immobilization, sling
- Reduction by physician
- Xray to make sure no fractures
- General body conditioning
- ROM
- Muscular strength
- Neuromuscular control
- Functional progressions
- Return to activity
SLAP tears (Labrum tear)
= Superior Labral tear Anterior to Posterior
Type 1:
- Partial tear of labrum where edges are roughened but not completely detached
- Tx is normally to clean the edges
Type 2:
- Most common
- Labrum is torn off the bone due to glenohumeral dislocation
- Tx is reattachment if the labrum (arthroscopically)
Type 3:
- “bucket handle” tear of labrum, torn piece hangs into GH joint and causes locking, popping and clunking
- Tx: removal or bucket handle segment
Type 4:
- Tear of labrum extends into long head of biceps tendon
- Tx is reattachment of labrum and repair of biceps tendon
Fraying of fibres
Surgery goes in to clean up edges
