Shoulder

Question 1

Why is the shoulder frequently injured?

Answer 1

• Ball and socket joint/ shallow socket
• Minimal bony stability
• Minimal mechanical protection
• Susceptible to:
  soft tissue injuries (mostly rotator cuff tears)
  fractures
  dislocations

Question 2

List most common traumatic injuries to the shoulder

Answer 2

• Falls (often on outstretched arm)
• High impact trauma:
  high impact falls
  MVA
  athletic injuries
  fractures of humeral head
  dislocations of gleno-humeral joint
  rotator cuff tears
• Impingement syndrome (also happens without trauma)
• AC joint separation
• Shoulder subluxation

Question 3

What area is most commonly fractured with a traumatic injury to the shoulder?

Answer 3

humeral neck

Question 4

Most common rotator cuff tears typically involve what tendon?

Answer 4

Supraspinatus

Question 5

95% of shoulder dislocations happen in which direction?

Answer 5

Anterior

Question 6

List the order of diagnostic imaging of the shoulder

Answer 6

1. X-rays (radiographs) - 1st line of defense – fractures, dislocations, arthritis
2. CT (computed tomography) – complex fractures, dislocations
3. MRI (magnetic resonance imaging) – soft tissue tears, impingement, instability
4. Diagnostic US – bursitis, tenosynovitis, rotator cuff (after arthroplasty), to guide arthrocentesis or injections

Question 7

Describe what to keep in mind when working with a painful shoulder

Answer 7

• Evaluate the scapulohumeral rhythm
• Painful shoulder is way too common in CVA clients
• Treatment = prevention
• Positioning is important
• DON’T USE PULLEYS!!! ( with CVA clients or those who have low tone / abnormal scapulohumeral rhythm )
• If you are considering a sling use a wear schedule to avoid tissue shortening in elbow
• Control edema with elevation, retrograde massage, and compression. (Can lead to complex regional pain syndrome)

Question 8

Symptoms of complex regional pain syndrome include…

Answer 8

• unprovoked, spontaneous, excess, and/or prolonged pain
• skin changes (texture/color)
• joint stiffening
• muscle atrophy
• impaired movement