Shoulder Flashcards
How common are sternoclavicular sprains?
rare
What is the MOI of SC sprain?
blow to lateral shoulder
What is the most common injury of the SC sprain?
the clavicle shifts forward
How can an SC sprain be life threatening?
if the clavicle is shifted backward
What is one of the most common injuries in sports?
clavicle fx
How can you get a clavicle fx?
fall on outstretched arm or fall on tip of shoulder or direct blow
What is the most common clavicle fx?
the middle third of the clavicle is fx
What does it feel like when you have a clavicle fx?
like your arm is falling off
Why does it feel like your arm is falling off with a clavicle fx?
it is the only thing holding the shoulder to the body
How do docs fix a clavicle fx?
must wear a figure 8 brace
What is the most common GH sprain?
anterior
What is the MOI for a GH sprain?
abduction, ext. rot., extension
What can a GH sprain cause?
pain and decreased ROM
What should you watch for with a GH sprain?
deformities
What can a GH sprain lead to?
chronic issues and dislocation
What should you do with dislocation?
immobilize and transport and watch pulses and neurological issues
What is the MOI for AC sprain?
fall on tip of shoulder or outstretched arm
What is Rockwood scale used for?
AC sprain
What is Rockwood scale grade 1?
a simple sprain
What is Rockwood scale grade 2?
rupture of AC
What is Rockwood scale grade 3?
rupture of both AC and CC ligaments and superior displacement
What is Rockwood scale grade 4?
posterior displacement
What is Rockwood scale grade 5?
superior displacement
What is Rockwood scale grade 6?
inferior displacement
What is required with AC sprain?
aggressive rehab (joint mobilization, flexibility exercises, strengthening, padding and protection, progress athlete as tolerated)
When would surgery be considered with an AC sprain?
with grades 4-6
What causes anterior subluxation?
forced abd and ext. rot.
What causes posterior subluxation?
forced add and int. rot.
S/S of anterior dislocation
flattened deltoid
prominent humeral head in axilla
arm carried in slight abd and ext rot
moderate pain and disability
S/S of posterior dislocation
severe pain and disability
arm carried in add and int rot
prominent acromion and coracoid process
limited ext rot and elevation
bankart lesion
permanent anterior defect of labrum
hill sachs lesion
caused by comprehension of cancellous bone against anterior glenoid rim creating a divot in the humeral head
SLAP lesion
defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum
What is blocker’s exotosis?
a contusion caused by a complication of myositis ossifications (calcium laid down in muscle)
What is the treatment for blocker’s exotosis?
ice, pad, doc referral, no u/s
What is the MOI of blocker’s exotosis?
repeated blows to the upper arm, usually at deltoid tuberosity
What is MOI of scapula fx?
direct impact or force transmitted up through humerus
What can get fx in scapula?
body, neck, glenoid (order of frequency)
S/S of scapula fx
pain during shoulder movement as well as swelling and point tenderness
MOI of humerus fx
direct blow or fall on outstretched arm
What fx is common in young athletes?
epiphyseal fx
S/S of humerus fx
pain, swelling, point tenderness, decreased ROM, deformity
management of humeral fx
remove from activity for 3-4 months
immediate application of splint, treat for shock, and refer
management of proximal fx
incapacitation 2-6 months
immediate application of splint, treat for shock, and refer
management of epiphyseal fx
quick healing- 3 weeks
immediate application of splint, treat for shock, and refer
Why is a humeral fx dangerous?
it can cause problems to nerves and blood supply
What is the most common fx of the humerus?
at the surgical neck
MOI of acute biceps rupture
forceful elbow flexion w/ heavy resistance
What’s the most common bicep rupture?
at proximal attachment
S/S of acute bicep rupture
pop, obvious deformity, tenderness
What is the ROM of the scapula?
elevation, depression, up rot, down rot, protraction, retraction, anterior tilt
What muscles make the scapula move?
trapezius, rhomboids, serratus anterior
What causes winging scapula?
serratus anterior weakness
What can winging scapula be associated with?
long thoracic nerve injury
What happens if there’s more mobility?
There’s less stability
What is scapulohumeral rhythm?
movement of scapula relative to the humerus
What happens when the humerus moves 30 degrees?
the scapula should not move
What happens when the humerus moves 30 to 90 degrees?
the scapula moves 1 degree of up rot for every 2 degrees of abd
What happens when the humerus moves past 90 degrees?
the scapula and humerus moves in a 1:1 ratio
MOI of chronic instability
trauma, repetitive microtrauma, congenital
What happens with anterior chronic instability?
clicking or pain, dead arm during cocking phase (of throwing), pain posteriorly, possible impingement, + apprehension test, + ant glide
What happens with chronic posterior instability?
possible impingement, loss of internal rotation, crepitation, increased laxity, pain anteriorly and posteriorly, + posterior glide
What happens with chronic multidirectional instability?
inferior laxity, + sulcus sign, pain and clicking w/ arm at side, possible S/S of anterior and posterior instability
What is the treatment for chronic instability?
scapula stabilization, posture, RTC strength
surgical repair- capsular plication, thermal shrinking
What muscles are in the anterior RTC?
supraspinatus and bicep tendon
What muscles are in the posterior RTC?
teres minor and infraspinatus
MOI for tendonopathy
overload activity especially 3/4 arm throw
S/S for tendonopathy
pain, inflammation, crepitus
What’s the difference between instability and laxity?
instability- worse, muscles can’t keep up, you get pain and have inability to perform
laxity- can keep joint stable, just have large ROM, generally no pain or limited motion
What is a glenoid labrum?
a cartilage ring around glenoid fossa to increase depth
How can you tear your labrum?
dislocation or biceps injury or instability
Type I SLAP lesion
fraying (degradation)
type II SLAP lesion
detached labrum from glenoid
type III SLAP lesion
bucket handle w/o biceps involvement
type IV SLAP lesion
bucket handle w/ biceps involvement
impingement syndrome
supraspinatus tendon gets pinched which damages bursa sac and long head of biceps
How can impingement happen?
with chronic instability or postural mal-alignment
What are the main components with impingement?
long head of biceps tendon
supraspinatus tendon
subacromial bursa
What can increase the chance of getting impingement?
hook shaped acromion
What does impingement cause (S/S)?
pain with 70-120 degrees of abduction
inflammation as structures are compressed
Neer’s Stage 1
result of supraspinatus or biceps tendon injury presenting w/ point tenderness pain w/ abduction and resisted supination w/ external rotation, edema, thickening of rotator cuff and bursa
Neer’s Stage 2
permanent thickening and fibrosis of supraspinatus and biceps tendon; presenting w/ aching during activity that worsens at night; may experience restricted arm motion
Neer’s Stage 3
history of shoulder problems and pain, tendon defect or possible muscle tear and permanent scar tissue and thickening of rotator cuff
need surgery
Neer’s Stage 4
infraspinatus and supraspinatus wasting, pain during abduction, tendon defect grater than 3/8”, limited active and full passive ROM, weak resistive ROM and clavicle degeneration
need surgery
What is the most common RTC tear?
supraspinatus
What does a RTC tear look like on a x-ray?
humeral head is elevated
S/S of RTC tear
same as impingement:
pain with 70-120 degrees of abduction
inflammation as structures are compressed
MOI in young athletes of RTC tear
continued impingement
Where does an RTC tear usually occur?
near insertion on greater tubercle
What happens with a RTC partial tear?
humeral head comes up and RTC starts to fray away
What are predisposing factors?
chronic instability
impingement
SLAP lesion
RTC tears
What is a frozen shoulder?
contracted and thickened joint capsule w/ little synovial fluid
What does a frozen shoulder cause?
chronic inflammation w/ contracted inelastic rotator cuff muscles and pain w/ motions resulting in resistance of movement
S/S of frozen shoulder
pain in all directions both w/ active and passive motion
Do we see a lot of frozen shoulders in athletes?
No, you get frozen shoulder from not doing anything. We make sure our athletes keep doing stuff.
What is good posture?
Scapula is retracted, tilted downward, and depressed
What posture is common?
kyphosis
What contributes to kyphosis?
sitting in class, playing video games, on laptop
What must we do to correct muscles?
work the muscles that do the opposite
What should be taken into consideration for looking at posture?
height, weight, and age dominant hand chief complaint body type muscle symmetry
ectomorph
very very lean (ex| CC runner)
mesomorph
some muscle (ex| bball)
endomorph
has cushion (ex| o-line guy)
What should you do when analyzing someone’s posture?
Take a picture and analyze later
Should you fix someone with a postural defect?
Only if it causes them pain or dysfunction
What is the most common postural defect?
cervical lordosis
What is cervical lordosis?
increased flexion of low c-spine and increased extension of upper c-spine
What is the result of cervical lordosis?
increased cervical disc pressure, stress on cervical faucets, stress on nerve roots, impingement on NV bundles, and stress on TMJ
What is scoliosis?
Rotation and side bending are coupled (one side of rib cage prominent). The convex side is lengthened and weak. The concave side is tight and weak.
What is a SICK scapula?
Scapular malposition
Inferior medial scapular winging
Coracoid tenderness
scapular dysKinesis
What are some causes of postural abnormalities?
injury
hyper/hypomobility
muscle imbalances and weaknesses
activity (sports)
What are some results of postural abnormalities?
inefficient or altered movement patterns
shortening/lengthening of structures
decreased performance/injury
