Shoulder Flashcards
1
Q
How common are sternoclavicular sprains?
A
rare
2
Q
What is the MOI of SC sprain?
A
blow to lateral shoulder
3
Q
What is the most common injury of the SC sprain?
A
the clavicle shifts forward
4
Q
How can an SC sprain be life threatening?
A
if the clavicle is shifted backward
5
Q
What is one of the most common injuries in sports?
A
clavicle fx
6
Q
How can you get a clavicle fx?
A
fall on outstretched arm or fall on tip of shoulder or direct blow
7
Q
What is the most common clavicle fx?
A
the middle third of the clavicle is fx
8
Q
What does it feel like when you have a clavicle fx?
A
like your arm is falling off
9
Q
Why does it feel like your arm is falling off with a clavicle fx?
A
it is the only thing holding the shoulder to the body
10
Q
How do docs fix a clavicle fx?
A
must wear a figure 8 brace
11
Q
What is the most common GH sprain?
A
anterior
12
Q
What is the MOI for a GH sprain?
A
abduction, ext. rot., extension
13
Q
What can a GH sprain cause?
A
pain and decreased ROM
14
Q
What should you watch for with a GH sprain?
A
deformities
15
Q
What can a GH sprain lead to?
A
chronic issues and dislocation
16
Q
What should you do with dislocation?
A
immobilize and transport and watch pulses and neurological issues
17
Q
What is the MOI for AC sprain?
A
fall on tip of shoulder or outstretched arm
18
Q
What is Rockwood scale used for?
A
AC sprain
19
Q
What is Rockwood scale grade 1?
A
a simple sprain
20
Q
What is Rockwood scale grade 2?
A
rupture of AC
21
Q
What is Rockwood scale grade 3?
A
rupture of both AC and CC ligaments and superior displacement
22
Q
What is Rockwood scale grade 4?
A
posterior displacement
23
Q
What is Rockwood scale grade 5?
A
superior displacement
24
Q
What is Rockwood scale grade 6?
A
inferior displacement
25
What is required with AC sprain?
aggressive rehab (joint mobilization, flexibility exercises, strengthening, padding and protection, progress athlete as tolerated)
26
When would surgery be considered with an AC sprain?
with grades 4-6
27
What causes anterior subluxation?
forced abd and ext. rot.
28
What causes posterior subluxation?
forced add and int. rot.
29
S/S of anterior dislocation
flattened deltoid
prominent humeral head in axilla
arm carried in slight abd and ext rot
moderate pain and disability
30
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
31
bankart lesion
permanent anterior defect of labrum
32
hill sachs lesion
caused by comprehension of cancellous bone against anterior glenoid rim creating a divot in the humeral head
33
SLAP lesion
defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum
34
What is blocker's exotosis?
a contusion caused by a complication of myositis ossifications (calcium laid down in muscle)
35
What is the treatment for blocker's exotosis?
ice, pad, doc referral, no u/s
36
What is the MOI of blocker's exotosis?
repeated blows to the upper arm, usually at deltoid tuberosity
37
What is MOI of scapula fx?
direct impact or force transmitted up through humerus
38
What can get fx in scapula?
body, neck, glenoid (order of frequency)
39
S/S of scapula fx
pain during shoulder movement as well as swelling and point tenderness
40
MOI of humerus fx
direct blow or fall on outstretched arm
41
What fx is common in young athletes?
epiphyseal fx
42
S/S of humerus fx
pain, swelling, point tenderness, decreased ROM, deformity
43
management of humeral fx
remove from activity for 3-4 months
| immediate application of splint, treat for shock, and refer
44
management of proximal fx
incapacitation 2-6 months
| immediate application of splint, treat for shock, and refer
45
management of epiphyseal fx
quick healing- 3 weeks
| immediate application of splint, treat for shock, and refer
46
Why is a humeral fx dangerous?
it can cause problems to nerves and blood supply
47
What is the most common fx of the humerus?
at the surgical neck
48
MOI of acute biceps rupture
forceful elbow flexion w/ heavy resistance
49
What's the most common bicep rupture?
at proximal attachment
50
S/S of acute bicep rupture
pop, obvious deformity, tenderness
51
What is the ROM of the scapula?
elevation, depression, up rot, down rot, protraction, retraction, anterior tilt
52
What muscles make the scapula move?
trapezius, rhomboids, serratus anterior
53
What causes winging scapula?
serratus anterior weakness
54
What can winging scapula be associated with?
long thoracic nerve injury
55
What happens if there's more mobility?
There's less stability
56
What is scapulohumeral rhythm?
movement of scapula relative to the humerus
57
What happens when the humerus moves 30 degrees?
the scapula should not move
58
What happens when the humerus moves 30 to 90 degrees?
the scapula moves 1 degree of up rot for every 2 degrees of abd
59
What happens when the humerus moves past 90 degrees?
the scapula and humerus moves in a 1:1 ratio
60
MOI of chronic instability
trauma, repetitive microtrauma, congenital
61
What happens with anterior chronic instability?
clicking or pain, dead arm during cocking phase (of throwing), pain posteriorly, possible impingement, + apprehension test, + ant glide
62
What happens with chronic posterior instability?
possible impingement, loss of internal rotation, crepitation, increased laxity, pain anteriorly and posteriorly, + posterior glide
63
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
64
What is the treatment for chronic instability?
scapula stabilization, posture, RTC strength
| surgical repair- capsular plication, thermal shrinking
65
What muscles are in the anterior RTC?
supraspinatus and bicep tendon
66
What muscles are in the posterior RTC?
teres minor and infraspinatus
67
MOI for tendonopathy
overload activity especially 3/4 arm throw
68
S/S for tendonopathy
pain, inflammation, crepitus
69
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
70
What is a glenoid labrum?
a cartilage ring around glenoid fossa to increase depth
71
How can you tear your labrum?
dislocation or biceps injury or instability
72
Type I SLAP lesion
fraying (degradation)
73
type II SLAP lesion
detached labrum from glenoid
74
type III SLAP lesion
bucket handle w/o biceps involvement
75
type IV SLAP lesion
bucket handle w/ biceps involvement
76
impingement syndrome
supraspinatus tendon gets pinched which damages bursa sac and long head of biceps
77
How can impingement happen?
with chronic instability or postural mal-alignment
78
What are the main components with impingement?
long head of biceps tendon
supraspinatus tendon
subacromial bursa
79
What can increase the chance of getting impingement?
hook shaped acromion
80
What does impingement cause (S/S)?
pain with 70-120 degrees of abduction
| inflammation as structures are compressed
81
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
82
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
83
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
84
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
85
What is the most common RTC tear?
supraspinatus
86
What does a RTC tear look like on a x-ray?
humeral head is elevated
87
S/S of RTC tear
same as impingement:
pain with 70-120 degrees of abduction
inflammation as structures are compressed
88
MOI in young athletes of RTC tear
continued impingement
89
Where does an RTC tear usually occur?
near insertion on greater tubercle
90
What happens with a RTC partial tear?
humeral head comes up and RTC starts to fray away
91
What are predisposing factors?
chronic instability
impingement
SLAP lesion
RTC tears
92
What is a frozen shoulder?
contracted and thickened joint capsule w/ little synovial fluid
93
What does a frozen shoulder cause?
chronic inflammation w/ contracted inelastic rotator cuff muscles and pain w/ motions resulting in resistance of movement
94
S/S of frozen shoulder
pain in all directions both w/ active and passive motion
95
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.
96
What is good posture?
Scapula is retracted, tilted downward, and depressed
97
What posture is common?
kyphosis
98
What contributes to kyphosis?
sitting in class, playing video games, on laptop
99
What must we do to correct muscles?
work the muscles that do the opposite
100
What should be taken into consideration for looking at posture?
```
height, weight, and age
dominant hand
chief complaint
body type
muscle symmetry
```
101
ectomorph
very very lean (ex| CC runner)
102
mesomorph
some muscle (ex| bball)
103
endomorph
has cushion (ex| o-line guy)
104
What should you do when analyzing someone's posture?
Take a picture and analyze later
105
Should you fix someone with a postural defect?
Only if it causes them pain or dysfunction
106
What is the most common postural defect?
cervical lordosis
107
What is cervical lordosis?
increased flexion of low c-spine and increased extension of upper c-spine
108
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
109
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.
110
What is a SICK scapula?
Scapular malposition
Inferior medial scapular winging
Coracoid tenderness
scapular dysKinesis
111
What are some causes of postural abnormalities?
injury
hyper/hypomobility
muscle imbalances and weaknesses
activity (sports)
112
What are some results of postural abnormalities?
inefficient or altered movement patterns
shortening/lengthening of structures
decreased performance/injury
