May30 M1-Shoulder Injuries Flashcards
swimmer shoulder = what type of injury + def
overuse injury (short term compared to inflam things like RA)
- bc of repetitive sub-maximal loading
- tissue fatigue
- inadequate recovery** (no rest)
- chronic degradation of affected tissue***
- no tissue adaptation
- microtrauma to inflammatory response to tissue damage
- cumulative mictrotrauma
tendinitis vs tendinosis
- tendinitis = inflammation around tendon itself (tenosynovial fluid)
- tendinosis = degeneration with microtears
tendinosis is not to be confused with what problem
acute sprains
sprain def + testing
- physical damage to passive soft tissue (ligaments, joint capsules) (sprain with p for passive)
- test with ligament stress test, stability testing, palpation
strain def + testing
- physical damage to active soft tissue (muscle, tendon, myofascial)
- test with strength testing, flexibility testing, palpation
grading of sprains and strains
- grade 1 = disruption of some fibers (acute microscopic tearing)
- grade 2 = partial tear (considerable disruption) (macroscopic tearing)
- grade 3 = complete tear (macroscopic tearing)
how swimmer shoulder (overuse injury) differs from acute tears
- acute tear = know exactly when happened
- overuse = gradual onset
- overuse = pain at rest and at night
swimmer shoulder specific symptoms
- pain occurs earlier in training with time
- anterior or lateral pain
- painful at certain mvmt
- pain at rest
- pain at night (indicates impingement)
- RC weakness WITH PAIN
RC muscles
- subscapularis
- infraspinatus
- teres minor
- supraspinatus
most affected RC muscle in swimmer shoulder
supraspinatus. most likely impinged in subacromial space
things to assess on swimmer shoulder physical exam
- impingement tests
- instability
management of swimmer shoulder
PHYSIOTHERAPY
- active rest (rest but do other sport to stay active)
- dry land training (cycling) especially lower extremities
what do PTs assess for swimmer shoulder
- RC injury?
- scapular stabilizer weakness (the primary problem in swimmer shoulder)?
- passive soft tissues too loose or too tight?
RC in swimmer shoulder
- often affected but is not the cause
- is affected secondarily to the first problem (which is scapular stabilizer weakness)
- It is in ACUTE injuries that RC is affected first
structures in the subacromial space
bottom to top = humerus, then muscle (inflamed if impingement), then bursa filled with fluid, then hooked acromion linked to coracoacromial ligament)
subacromial impingement is what
- RC travelling between acromion and humeral head (supraspinatus m. or other m.)
- reduced space in that area so muscle impinged and inflamed. less ROM bc hits the acromion earlier
what is the cause of a long term (not acute) RC injury
an imbalance between stabilizer (the RC muscles) and mobilizer muscles
how can you assess for scapular stabilizer weakness
check for winging
how do you assess for posterior shoulder stiffness (seen not in swimmers but in throwing sports)
- flex forearm 90 degress + ABDuct 90 degrees lie on bed
- test ROM arm most to back and front (external and internal rot)
- 0 degrees = hand to the sky
- normal = 110 deg ext 70 deg int
- abnormal = 135 deg ext 45 deg int (still 180 deg but lose internal rotation)
cause of posterior shoulder stiffness
repetitive rotation causes stress on RC bc it is stretched at end of ROM or internal rotation
posterior capsule tighteness is what
tightness of the glenohumeral capsule (ligament) in the back causing impingement (blocking humeral head on glenoid fossa bc pushing on humeral head forward)
tx of overuse injuries
- address the underlying weakness or problem
- NSAID? (if yes, short term)
- steroid injection?
- surgery?
tx of swimmer shoulder specifically
- 7-10 days NSAIDs (NSAIDs for a year in RA, not here)
- subacromial steroid injection (if constant pain and PT doesn’t help anymore)
- surgery if pain persists (but is not common for tendinosis)
surgery for swimmer shoulder is when
- labral tear (tear of labrum, the cartilage)
- anatomic anomaly of acromion (hooked)
most frequently dislocated joint
glenohumeral
-often anterior
-rarely posterior
(is a contact injury)
what’s the vulnerable position for anterior dislocation of the shoulder
forced extension, ABDuction, external rotation
diff hx you can see in anterior shoulder dislocation
- acute trauma first time felt it popping
- no acute trauma (dislocates with simple activities like putting jacket on)
- recurrent dislocators (multidirectional instability)
PE in anterior shoulder dislocation
- tenderness around shoulder
- pt passive and reluctant to moving
- hollow below acromion
- possible C5 axillary nerve damage (lose sensation on lateral shoulder)
(imp) what’s a Bankart lesion
injury to anterior labrum due to anterior shoulder dislocation
labrum attachment to ant glenoid
(imp) what’s a bony Bankart lesion
anterior glenoid rim fracture due to anterior shoulder dislocation
what’s a Hill-Sachs lesion
impression (compression) fracture posterior superolateral side seen in anterior shoulder dislocation
other problems seen in anterior shoulder dislocation
- RC tears
- greater tuberosity fractures
- these are in elderly + can have axillary n. damage*
imaging for anterior shoulder dislocation
- XR trans-scapular Y views and AP, lateral, axillary view for bone
- US or MRI for RC tear
- CT or MRI for subtle fractures like Bankart (glenoid rim)
- 3T MRI or MR-arthrogram for labral tear
(EXAM) posterior shoulder disloation charact
- from direct high energy trauma or seizures or electrocution
- arm in internal rotation or ADDuction
- sudden contraction of internal rotators which are stronger than external for example
(EXAM) reverse Bankart lesion is what
injury to posterior labrum
labral attachment to posterior glenoid
(EXAM) reverse bony bankart is what
posterior glenoid rim fracture
reverse Hill-Sachs lesion is what
impression fracture antero-medially
associated injuries with posterior shoulder dislocations
- RC tears
- LESSER tuberosity fractures
- axillary n. damage is rare
imaging for posterior shoulder dislocation.
same as anterior
tx of acute shoulder dislocation
- reduce (replace) the humerus. have to assess neurovascular status before and after
- easier with less muscle spasm
contraindications to reducing a shoulder dislocation
- subclavicular or intrathoracic dislocation
- humeral neck fracture
what do you do post shoulder reduction
sling immobilization for 1-3 weeks + PT
(EXAM) education to give after shoulder dislocation
- anterior = no abduction + external rotation for 6 weeks (stresses capsule and torn ligament)
- posterior = avoid internal rotation and adduction for 6 weeks
tx for recurrent shoulder dislocation
- lot of PT
- bracing
- surgery (+ if assoc injury)
early surgery for shoulder disloc reasons to do
- avoids recurrent instability and dislocation which is common in young
- more stable = less OA
what’s an absolute indication for surgery in shoulder dislocation
associated injuries (is the most important one) \+ other things like failed rehab, etc.
