mid sem Flashcards
Ant instability
- Displacement of humeral head – no longer in centre > joint surfaces no longer touch
- Explain types of instability
- Anterior most common
Symptoms: increased disslocations/subluxations, anterior shoulder pain, transient numbness and weakness, kind of like a dead arm, popping out and notice intermittent catching, clicking and impingement of the shoulder.
Affects structures that usually stop anterior subluxation from occurring. Gradual breakdown of active and passive restraints.
MOI:
overhead athletes w/ capsular laxity
o Post- traumatic- excessive abduction and/or external rotation
o Atraumatic - Acute traumatic episode in a lax shoulder
o Congenital- shape of glenoid, musculature
o Overuse - Repetitive load or action (throwers, swimmers, overhead athletes) causes microtrauma due to increased humeral head translation
♣ Motor control concerns – consider force couples that act to keep the HOH well positioned in the glenoid.
Symptoms
o Recurrent dislocation or subluxation
o Anterior shoulder pain
♣ arising from impingement of the rotator cuff tendons associated with recurrent anterior translation of the HOH can result in RC tendinopathy
♣ catching of a labral detachment
o Feeling that the shoulder is popping out +/- apprehension
♣ Starts with activities in ER and ABD but then more frequent and with simple activities such as rolling over in bed
o Transient numbness and weakness in the arm (‘dead arm syndrome’)
♣ Mechanical tension on brachial plexus and inflammation which may degrade the myelin of the nerve ectopic discharge
o Intermittent impingement, catching, clicking , clunking (due to labral involvement and translation of HOH)
Management depends on severity
Aim: increase local shoulder stability and correct abnormal shoulder movement
1st = local conscious muscle control
- Go into strengthening exercises – closed (strength, co-contraction) > open
- Increase load and mvmt
- Progress to functional positions to recuit kinetic chain
- maintain general fitness
Disslocation
- Ball is forced all way out of socket > stretching/tearing of ligas
- Ant more common
- Change way muscles work to improve stability
- May localised pain, decreased mvmt, swelling, brusiing
- Increased risk of reoccurrence –
- Bankart lesion (anterior, inferior labrum) - xray
- Address axillary nerve –tingles and numbness
- Conservative appropach
Reduce = ice, Bracing (3 weeks) as sling puts are into further IR which increases Bankart lesion > pendulum > - Once pain subsides, gentle activations > progress further in to range + load > sports specific drilss > simulated play > RTS if full rom, pain free
- Work on strength and control
- Maintain general fitness
- If doesn’t improve then go into surgery
disslocation - bankart
- If repaired/arthroscopy: immobilisation in 3-4wks, Gentle pendulum exercises on day one; active ER ROM once pain subsides, then active IR ROM gradually introduced
- Strengthening at 6 weeks and RTS generally at 3 months
Bony: Post-op protocol (example): § Sling 3 weeks § Then gentle mobilisations § Start strengthening & stabilisation exercises after 4-6 weeks § Full ROM after 8 weeks § Return to sport after ~12 weeks
Impingement:
- Top of shoulder put pressure on underlying soft tissues when arm lifted away from body
- impingeing in sub acromial space > pain and decrease function and discomfort
- impingement due to RC weakness or skap dyskinesis
- can retrain muscles
ask what understood
gentle activation
- gentle contractopns – build RC strength and control > progress through ROM + load
- avoid aggravating positions – 70 – 120˚ - use other arm, modify
- correct scapulae mvmt
Tendinopathy:
- common in overhead athletes
- intrinsic: originates within the tendon, usually as a consequence of overuse or overloading
- or extrinsic includes compression or irritation of the upper part of the tendon to where the tendons come into contact with the shoulder blade when lifting the arm above head
- graded 1 - 4
- evaluate
- reduce symptoms: avoid positions, no sling – frozen shoulder, ice
- stretching exercise recommended early to maintain joint mobility – one per day, everyday
- once pain permites, - gentle activation > strength
- expect mild pain, no longer than 24hrs if so rest and ice.
- Address training errors eg imbalance btwn IR and ER
- 6 – 12 weeks improve
maintain fitness, don’t want to progress into a tear
tear
2 type: acute result of recent injury – FOOSH or jerky arm
or degenerative – wearing down as the body ages
- partial or complete
- symptoms – sleep, lateral arm, overhead activities,
- pain doesn’t reflect severity
conservative recommened:
- reduce symptoms: avoid positions, no sling – frozen shoulder, ice
- stretching exercise recommended early to maintain joint mobility – one per day, everyday
- once pain permites, - gentle activation > strength
- expect mild pain, no longer than 24hrs if so rest and ice.
- If doesn’t improve – look into surgical
- Generally 6 months of rehap after surgical repair
- maintain fitness
GIRD
= posterior capsule works to slow down in follow through
- causes tightness in posterior muscles
- assoicated with acquired instability - overhead overuse
Stretching, once day everyday to prevent injury
3 reps of 30 secs sleeper stretch for 6 weeks
+ foam roller
+ progressive ER strengthening when symptoms subside
- in clinic do some mobilisation with movement
Adhesive
diopathic disease
Due to acute trauma/surgery or general wear and tear. Explain anat
-So the bone, ligaments and tendons that make up your shoulder joint are encased in a capsule connective tissue. Frozen shoulder occurs when this capsule thickens and tightens around the shoulder joint, restricting movement.
Three stages (over a 2 year period)
1. Painful/Freezing: 3mths weeks occurring spontaneously with increasing shoulder stiffness – people describe burning sensation in delts and radiates down forearm
2. Stiffening/Frozen: lasting 4-12 months – pain in extremeities of motion
o Thawing: lasting 5-26 months (includes gradual recovery of range
3. Gradual loss of ROM and increasing pain
Issues sleeping
In the majority of cases, it is self-managed and immobilization/ activity modification is not necessary” resolves spontaneously around 1.5yrs - if idiopathic
surgical or post injury - 12 months
focus on reducing your pain during this first painful phase and then as it starts to resolve we will begin doing some mobilisation movements of your shoulder and begin a home stretching and strengthening program to help the natural recovery process.
- surgerical, injections, physio for idiopathic
SLAP
- address abnormal scap and GIRD
- is the separation of the labrum from the glenoid that begins from the back and extends forwards to the biceps tendon which also attaches to labrum
- when we carry or drop heavy objects it puts a lot of force on this muscle and it can detach from the labrum, causing a little tear. Traction on the arm or compression loading on the shoulder from a fall on the hand in forward shoulder flexion and abduction
- Deceleration/late cocking phases of throwing
- More common in males, overhead athletes
- -4 types (stable or unstable): 1frayed and degenerative labrum > type 4: extension of tear through labrum to biceps tendon
- symptoms: posterior superior pain, decreased throwing power, report symptoms of instability , intimittent pain
- management = increase awareness of control of scapular position, decrease tightness of capsule (stretching) – sleepers stretch, address any instability,
- Success in conservative Mx = RTS at 3-6 months
- Success in surgical repair and rehabilitation = return to function at 6-10 months
AC
- Explain anat
- Fall on point of shoulder/direct blow – forces acromion
- 6 class classification
- symptoms = immediate pain, heavy lifting, bruising/swelling, decrease mob, clavicle visually displaced
check
feel better within week but takes 6 weeks for ligs to heal
- prevent overstreaching of scar tissue
- ice, sling = 2-3 days for type 1, 6 weeks for more
- isometrics exercises once pain permits, gentle roms
- for grades higher than 3, scap movement retraining
- RTS when pain free and full rom
- taping
