Shoulder Flashcards
What positive special tests are indicative of a SC sprain?
SC compression test & SC joint integrity
What is the MOI of an SC sprain?
Blow to the lateral shoulder.
What is a shoulder injury that is one of the most common fractures in sports?
Clavicular fracture
What is the MOI of a clavicle fracture?
FOOSH, falling on the tip of the shoulder, and direct impact.
What portion of the clavicle is the most commonly fractured? Why?
The middle third. The weakest spot is right in the curve of the “s”
If an athlete describes their injury as “their arm feels like it’s falling off” it is most likely what injury?
Clavicle fracture because the clavicle is the only connection of the arm to the axial skeleton.
What positive tests could indicate a clavicular fracture
Compression tests, tap test, tuning fork
If you suspect a clavicular sprain, your mode of action should be?
Refer to the ER immediately.
What is the MOI of an AC sprain?
Falling on the tip of the shoulder or FOOSH?
What scale is used to assess the severity of AC joint sprains?
Rockwood scale.
What is indicative of a grade I AC sprain?
A simple sprain with no elevated clavicle. It is still relatively functional.
What is indicative of a grade II AC sprain?
A rupture of the acromioclavicular ligament. There is typically only minimal clavicle displacement.
What is indicative of a grade III AC sprain?
A rupture of both the acromioclavicular and coraclavicular ligaments with superior displacement of the clavicle.
What positive tests indicate an AC sprain?
AC compression, piano key, AC joint integrity, and SC compression.
What grades of AC sprains typically can require surgery?
Grades IV, V, and VI.
What injury is common in wrestlers and football players?
SC sprains.
What type of glenohumeral sprain or dislocation is the most common?
Anterior
What is the MOI for a glenohumeral sprain or dislocation? (Anterior)
Abduction, external rotation, and extension.
What is indicative of a grade IV AC sprain? Grade V? Grade VI?
IV= posterior displacement of clavicle V= superior displacement (3x-5x) of clavicle VI= inferior displacement of clavicle
What is the typical approach to fix a grade IV, V, or VI AC sprain?
Surgery
What positive tests are indicative of an AC sprain?
AC compression
SC sheer
Piano key
How treat an AC sprain?
Padding and protection
Joint mobilization, flexibility exercises, & strengthening
What kind of glenohumeral dislocation is the most common?
Anterior
What is the MOI for a glenohumeral dislocation or sprain?
Abduction, external rotation, and extension
How do you deal with a glenohumeral dislocation?
Immobilize and splint in the position they’re in
Check for pulses and neurological signs
What are some symptoms of a glenohumeral dislocation?
Pain and decreased ROM
What is the difference between a dislocation and subluxation?
In a dislocation, the joint comes completely out and then either stays out or goes back in.
In a subluxation, the bones partially come out of the joint and then go back in.
What is the etiology of an anterior subluxation or dislocation?
Anterior force on the shoulder
forced abduction and external rotation
What is the etiology of an posterior subluxation or dislocation?
Posterior force on the shoulder
forced adduction and internal rotation
What are some possible complications of a shoulder dislocation?
Bankart lesions, hill sachs lesions, SLAP lesions, comprimise brachial nerves & vessels, rotator cuff injuries, bicipital tendon subluxation and transverse ligament rupture.
What is a bankart lesion?
A permanent anterior defect of the labrum. It is a tear that occurs from 3:00-6:00 on the labrum (anterior or anteior/inferior).
What is a Hill sachs lesion?
A divot in the humeral head caused by compression of the cancellous bone against the anterior glenoid rim.
What does SLAP stand for in a SLAP lesion?
Superior Labrum Anterior Posterior
What is a SLAP lesion?
A defect in the superior labrum that begins posteriorly and extends anteriorly (from 9:00-3:00). It impacts the attachment of the long head of the biceps tendon on the labrum.
What age group does a Hill sachs lesion typically affect?
Children or teens (or people that dislocate/sublux their shoulder often).
What is the MOI of a scapula fracture?
Direct impact or force that is transmitted up through the humerus to the scapula.
What is the most frequently seen scapular fracture?
1) body (45% of scapular fratures)
2) neck
3) glenoid
What are signs and symptoms of a scapula fracture?
Sharp pain during shoulder movement as well as swelling and point tenderness, nausea
How common is a scapula fracture?
Less than 10%
What is blockers extosis?
A contusion of the muscle overlying the deltoid tuberosity. There is a buildup of calcium on the tuberosity that causes the calcium to be laid down in the muscle (myositis ossificans). This laid down calcium inflames the muscle.
What is the MOI of blockers extosis?
Repetitive blows to the upper arm (often at the edge of the shoulder pads)
What is the treatment for blockers extosis?
Ice, pads, NO ULTRASOUND
probably see a doctor for a prescription
What is the MOI of a humeral fracture?
Direct blow or FOOSH
What types of humeral fractures are more common in young athletes? What are they caused by?
Epiphyseal fractures;
They’re caused by a direct blow or an indirect blow traveling along the the long axis of the humerus.
What are some signs & symptoms of a humeral fracture?
Pain, swelling, point tenderness, decreased ROM, and deformity.
How do you manage a humeral fracture?
Splint, treat for shock if necessary, and refer immediately.
How long does is the recovery time typically for a humeral fracture? Epiphyseal fracture? Proximal fracture?
Humeral fracture= 3-4 months
Epiphyseal fracture= 3 weeks
Proximal fracture= 2-6 months
Where do humeral fractures most commonly occur?
The surgical neck.
What do you need to be concerned about with a humeral fracture?
Blood vessels and nerves
What is the MOI for an acute biceps rupture?
Forceful elbow flexion with heavy resistance (it is typically preceeded by a microtrauma of some sort)
What are some signs & symptoms of an acute biceps rupture?
Pop, obvious deformity, tenderness.
Where does a biceps tendon rupture typcially occur?
At the proximal attachment
What special test can be used to diagnose a biceps tendon rupture?
Ludingtons
What are the 3 “joints” of the shoulder?
Glenohumeral, acromioclavicular, and scapulothoracic.
What are the static stabilizers of the shoulder joint?
Bones, ligaments, and tendons.
What are the dynamic stabilizers of the shoulder joint?
Muscles (rotator cuff and long head of the biceps)
We give up what in order to have more mobility at the shoulder joint?
Static stability.
What muslces help to hold the humeral head in the glenoid fossa during overhead motion?
The supraspinatus compresses the head while other rotator cuff muscles depress the humeral head during overhead motion.
What is scapulohumeral rhythm?
The movement of the scapula relative to the humerus.
Describe scapulohumeral rhythm.
- During the initial 30 degrees of abduction, there is no movement of the scapula.
- During the next 60 degrees (from 30-90), the scapula abducts and upwardly rotates 1 degree for every 2 degrees of humeral elevation.
- After 90 degrees, the scapula and humerus move in a 1:1 ratio
Weakness in what muscle can cause a winging scapula?
Serratus anterior
Injury to what nerve can cause a winging scapula?
Long thoracic
What are the three types of chronic instability?
Anterior, posterior, and multidirectional
What is the MOI of chronic instability (x3)?
Trauma
Repetitive microtrauma
Congenital
What are the signs and symptoms of chronic instability?
Pain, clicking, dead arm (the humeral head slips anterior or anterior-inferior and they can’t produce a force)
What positive tests can indicate chronic anterior instability?
Anterior apprehension test
Anterior drawer test
What are some specific signs and symptoms with anterior chronic instability?
Clicking, pain, dead arm during cocking phase of throwing, posterior pain.. Possible impingement
What are some specific symptoms with posterior chronic instability?
Possible impingement, loss of internal rotation, crepitation, increased laxity, posterior and anterior pain.
What positive tests can indicate posterior instability?
Posterior drawer
What are some specific signs and symptoms with multidirectional instability?
Inferior laxity, positive sulcus sign, pain and clicking with the arm at the side, may have some same symptoms as anterior and posterior instability.
What positive tests can indicate multidirectional instability?
Sulcus sign..
What is the difference between hypermobility/laxity and chronic instability?
Chronic instability is accompanied by pain and a decrease in function.
What are the most common types of chronic instability?
Multidirectional and anterior
What are some ways to test if an athlete is just naturally hypermobile (global laxity)?
- hyperextend knee or elbow
- put their pinky perpendicular to the floor
- put their thumb to their arm
What muscle is associated with anterior RTC tendonopathy?
Supraspinatus
What muscle(s) is associated with posterior RTC tendonopathy?
Teres minor & infraspinatus
In addition to the anterior RTC and posterior RTC, what can also suffer from tendonopathy?
Long head of the biceps
What do we need to watch for with if an athlete has tendonopathy of the long head of the biceps?
The tendon subluxing out of the bicipital groove–could indicate a torn transverse ligament
What are the signs and symptoms of tendonopathy of the shoulder?
Pain, inflammation, crepitus
What is the MOI of tendonopathy?
Overhead activity (especially the 3/4 throw)
What is a way to treat tendonopathy of the shoulder?
Treat with eccentric training or massage to try and stimulate the inflammation process–this will help bring in more collagen and resume the healing process.
What is the glenoid labrum?
A cartilage ring around the glenoid fossa that is supposed to increase its depth and surface area to better hold the humeral head against the glenoid fossa.
What is the glenoid labrum attached to?
The long head of the biceps–so it can be torn with a biceps injury
What is a SLAP lesion?
A lesion that occurs at the long head of the biceps origin on the glenoid labrum. It is common with instability.
What does SLAP stand for? Where does it take place on the glenoid?
Superior Labrum Anterior Posterior
It takes place in the 3:00-9:00 range.
What positive tests can indicate a slap lesion?
O’Brien’s
Biceps Load II
Clunk
How many types of SLAP lesions are there? What are they?
4:
I = fraying (degeneration)
II = detached labrum from glenoid
III = bucket handle without biceps involvement
IV = bucket handle with biceps involvement
What structures are typically involved with secondary anterior impingement? (x3)
Long head of the biceps
Supraspinatus tendon
Subacromial bursa
**structures that pass in the subacromial arch
What other problems is secondary impingement oftentimes associated with?
Chronic instability
Postural mal-alignment
Scapular dyskinesis
Poor RTC strength
True or False:
Anterior and posterior impingement affect NAV status.
False
What is primary impingement?
Impingement that is caused by a structural problem. The problem (usually a hook off the acromion) is causing the impingement directly.
What is the painful arc that is seen with impingement?
60-120 degrees of abduction.
Who developed the stages of shoulder impingement? How many are there?
Neer; 4
Which stage of impingement is caused by a biceps tendon or supraspinatus injury? What does it usually present with?
Stage I:
point tenderness, painful abduction, resisted supination with external rotation, edema, and thickening of RTC and bursa
Which stage of impingement results in a permanent thickening and fibrosis of the supraspinatus and biceps tendon? What does it usuallly present with?
Stage II:
aching during activity that worsens at night, may experience restricted arm motion
Which stage of impingement results in a history of shoulder problems, defect in the tendon(s), possible muscle tear, or permanent scar tissue and thickening of the rotator cuff?
Stage III: visibile defect or hole
Which stage of impingement results in infraspinatus and supraspinatus wasting? What does it usually present with?
Stage IV: RTC tear
painful abduction, tendon defect greater than 3/8”, limited AROM and PROM, weak RROM, and clavicle degeneration
Which stage of impingement may be able to be treated without any permanent damage?
Stage I-supraspinatus or biceps tendon injury.
Chronic instability increases an athlete’s risk for what other two shoulder problems?
SLAP lesions & impingement
What is the MOI of posterior (interior) impingement?
Repetitive stress
Where does pain present in posterior impingement?
In the posterior joint line when abducted to 90 degrees.
What occurs during posterior (interior) impingement?
The humeral head translates anteriorly which results in a posterior “pinching” of the joint capsule, labrum, and posterior RTC.
What is posterior (interior) impingement usually associated with?
Chronic instability, postural mal-alignment, scapular dyskinesis, poor RTC strength, and GIRD (glenohumeral internal rotation deficit)
What is GIRD?
Glenohumeral internal rotation deficit. It occurs when there is a loss of the 180 degree rule–aka the athlete cannot reach the full 180 degrees.
Which RTC muscle is the most commonly torn?
Supraspinatus near its insertion on the greater tubercle
What is the MOI of a RTC tear in the young athletic population?
Continued impingement
Displaying weakness during what tests could indicate a possible RTC tear?
Empty can & drop arm
What are the four predisposing factors to repetitive stress shoulder injuries?
Chronic instability
Impingement
SLAP lesions
RTC tears
What is the technical term for frozen shoulder?
Adhesive capsulitis
What are the signs and symptoms of frozen shoulder?
Pain in all directions with both AROM and PROM
What can cause frozen shoulder?
Contracted & thickened joint capsule (with little synovial fluid) or chronic inflammation with contracted inelastic RTC muscles. It often occurs after injury or surgery because the patient is apprehensive to using that shoulder.
What special tests are good for acute injuries?
Apprehension (not chronic because they patient is not necessarily in pain–they’re more just hurting all the time)
What happens as a result of cervical lordosis? (x5)
Increase cervical disk pressure, stress on cervical facets, stress on nerve roots, impingement of neruovascular bundles, and stress on TMJ
What are the weak muscles in upper cross syndrome?
Deep neck flexors
Rhomboids and lower trapezius
What are the tight muscles in upper cross syndrome?
Upper trapezius and levator scapulae
Pec major and minor
What is a SICK scapula?
S= scapular malposition I= inferior medial scapular winging C= coracoid tenderness K= scapular dysKinesis
What are some of the causes of postural abnormalities?
Injury, hyper/hypomobility, muscle imbalances (upper cross syndrome), congenital, or activity (sports or habits)
What is the condition of the muscles on the concave side in someone with scoliosis? The convex side?
Concave= tight, weak Convex= lengthened, weak
Onset of pain is?
Acute? Or repetitive stress?
Location of pain?
Anterior?
Posterior?
Medial?
Lateral?
SC sprains can be life threatening if?
They displace backwards (into chest cavity)
SC sprain most commonly shift?
Forward
Scapular range of motion includes?
Elevation/Depression
Upward/downward rotation
Protraction/retraction
Anterior tilt
S/s of biceps rupture
Sudden pain/snap
Bulge in muscle belly - popeye
Weakness
Tests for SLAP Lesions?
O'Brien's test Clunk test Biceps Load II test Grind test SLAP test?
Anterior impingement usually involves?
Long head of biceps tendon
Supraspinatus tendon
Subacromial bursa
Posterior impingement usually involves?
“Pinching of joint capsule/labrum and posterior rotator cuff
Most commonly torn rotator cuff muscle
Supraspinatus
Functional assessment of rotator cuff
Apley’s scratch
Gerber’s lift off
180 degree rule
Repetitive stress injuries - special tests
Empty/full can
External rotation MMT
Speed’s test
Yeargson’s
