Shoulder Flashcards
The shoulder is susceptible to injury because _______
There is more mobility compromising the stability
This places great stress on the complex
Repetitive movements
Examples of repetitive movements
Throwing
Swimming
Serving in tenis or volleyball
FOOSHA
Falling on outstretched hand/arm
S shaped, 6 in long, supports anterior shoulder
Clavicle
Prone to fx because of shape and not protected
Clavicle
Flat, triangular, purpose is an articulating surface for the humerus
Scapula
Humerus structures
Head, neck, bicipital groove, greater and lesser tubercle and glenohumeral joint
Most frequent fracture
Clavicular
FOOSHA, direct impact, occurs in middle 3rd with athlete supporting arm, swelling deformity, point tenderness. They’ll often tip their head to the opposite side
Clavicular fracture
Direct blow or fall on arm with inability to move arm, swelling, point tenderness and discoloration
Humeral shaft fracture
Great danger to nerve and vessels, direct blow, discoloration, most likely at neck and can be mistaken for dislocation
Proximal humerus fracture
Young athlete 10 years and younger with a direct blow or indirect force applied to length of axis
Epiphyseal fracture
Brief translation of the humeral head without separation of the joint surfaces
Or in English, the joint comes out but goes back in
Subluxation
Most common dislocation
Anterior dislocation
Forced abduction, external rotation and extension, direct impact to the posterior or posteriolateral aspect with a flat deltoid, you can feel the humeral head and the athlete carries the affected arm in slight abduction and ER. They are unable to touch the opposite shoulder
Anterior dislocation
Forced adduction and IR or fall on outstretched and IR arm with labrum damage, severe pain and disability, limited ER and elevation
Posterior dislocation
Clavicle + manubrium of sternum, only direct connection between upper extremity and trunk
Sternoclavicular joint
Articulation disk that absorbs shock and allows movement
SC joint
Lateral end of clavicle and acromion process, weak junction
Acromioclavicular joint
Ball and socket joint, head of humerus and glenoid cavity of scapula held together by the glenoid labrum
Glenohumeral joint
Not a true joint, scapula + thoracic cage
Scapulathoracic joint
Pulls clavicle downward and toward sternum
Sternoclavicular ligament
What are you going to see in a grade 1 AC joint sprain
Mild point tenderness
Discomfort with movement
No deformity
Mild stretching of AC lig
What are you going to see in a grade 2 AC joint sprain
Moderate tearing or rupture of AC lig Stretching or tearing of coracoclavicular lig Displacement of distal end of clavicle Moderate pain Unable to abduct arm through full ROM
What are you going to see in a grade 3 AC joint sprain
Rupture of the AC and CC lig Dislocation of clavicle Gross deformity LOF Instability
Athlete is sitting or standing, push down on clavicle
Piano key
Piano key positive test
Movement of clavicle
Athlete sitting or standing
Heel of one hand on spine of scapula
Heel of other hand on clavicle
Squeeze
Compression/squeeze
Compression/squeeze positive test
Movement and pain
Forced abduction, external rotation, direct blow with pain w/movement and palpation, decreased ROM
Glenohumeral joint sprain
Athlete supine, stabilize the shoulder, hand around humerus, pull head anteriorly and push head posteriorly and inferiorly
GH glide/Load and shift
GH glide/Load and shift positive test
Laxity compared bilaterally
Athlete standing
Stabilize shoulder
Pull arm down
Eyes on middle deltoid watching for sulcus (sucking in)
Sulcus
Sulcus positive test
Observable gap
Athlete sitting or standing
Passively put into external rotation w/humerus parallel to ground
Apprehension crank
Apprehension crank positive test
Apprehension/resistance
Overuse in overhead activity with pain in the anterior upper arm over bicipital groove while performing overhead activity
Bicipital tenosynovitis
Athlete is sitting or standing
Elbow at 90 degrees and forearm pronated
Athlete attempts to move into supination against resistance
Yergason’s test
Positive test for yeragsons
Pain in bicipital groove
Athlete sitting or standing
One hand on bicipital groove
Other hand is resisting movement at forearm
Resist shoulder flexion
Speeds
Speeds positive test
Pain in bicipital groove
Athlete sitting or standing
Bring both arms up to 90 degree flexion and 30 degrees of horizontal abduction
Tell athlete to hold position and push down on arms
Empty can
Empty can positive test
Weakness or pain in shoulder
Athlete sitting or standing
Athlete activity goes into full abduction
Then drops down and holds at a 90 degree position
Drop arm
Positive test for drop arm
Athlete cannot hold a 90 degree position
Complains of diffuse pain, overhead activities increase pain, painful arc, pain in insertion of supraspinatus
Shoulder impingement
Athlete stands/sits or supine
Passively put into IR and bring shoulder into flexion
Neer
Neer’s positive test
Pain at AC joint
Athlete sitting or standing
Passively put into shoulder flexion with elbow bent
Passively IR the arm
Hawkins Kennedy
Hawkins Kennedy positive test
Pain at the AC joint
Buildup of fluid caused by chronic inflammation, overuse, or a direct impact and there is pain with movement and tenderness
Shoulder bursitis
What bursa is most inflamed with shoulder bursitis
Subacromial
Subjected to trauma with overhead positions compressing the bursa under the coracoarcemia arch; most important
Subacromial bursa
Subacromial nerve supply
Brachial plexus (C5-T1)
Subacromial blood supply
Subclavian, brachial and axillary arteries
Compression of brachial plexus and or subclavian artery with pain and paresthesia
TOCS “stingers”
Serratus anterior weakness means
2 scapula wing
Thoracic nerve injury means
One scapula wings
Describes the movement of the scapula relative to the movement of the humerus through a full range of movement
Scapulohumeral rhythm
How do you prevent a shoulder injury
- Proper total physical training through full ROM
- Proper warm up
- Instruction on how to properly fall
- Appropriate techniques must be taught
How do you fall
Shoulder pads
Shoulder roll
Not without stretched hand/arm
History
Type of pain
Specific movements that cause pain
Pins and needles
Radiating pain from cervical pathology
Sharp pain
Acute inflammation
Dull, aching, sense of heaviness
Chronic rotator cuff
Deep, aching pain in the neck, shoulder region
TOCS
Night pain
Rotator cuff tear
Burning pain
Acute tendinitis
Weakness, numbness
Nerve pathology
Pain with movement of the neck may mean
Cervical spine injury
Pain with shoulder external rotation may mean
Dislocation/subluxation
Pain with movement above 90 degrees
ACJ
Observations should be done
From all sides
Anteriorly
Posteriorly
Laterally
When observing from all sides look for
Symmetry Hypertrophy Deformity Discoloration Swelling How is the shoulder carried
When observing from the anterior side look for
Step deformity at the ACJ
Flat deltoid
When observing from the lateral side look for
Kyphosis
Scoliosis
Shoulders slumped forward
Kyphosis
Forward or backward arm hang
Scoliosis
When observing from the posterior side look for
Muscle definition
Scapulohumeral rhythm
Scapular winging during flexion and abduction
Anterior bony palpations
Clavicle SC joint AC joint Coracoid process Humeral head Sternum Bicipital groove
Posterior bony palpation
Scapula Spine of scapula Medial border of scapula Inferior angle Lateral border
Anterior soft tissue palpation
AC and SC joint ligaments Deltoid Rotator cuff tendon Sternoclediomastoid Biceps muscle and tendon
Posterior soft tissue palpation
Rhomboids Levator scapulae Trapezius Supraspinatus Infraspinatus Teres minor/major Latissimus dorsi
Phase 1 Rehab
Wall walks
Tubing
Strengthening
Pendulum
What do wall walks do
Regains ROM in flexion and abduction
What does tubing do?
Helps strengthen scapular stabilization
Types of strengthening for phase 1 rehab
I’s Y’s and T’s
Rhomboids
Wall pushups
Ceiling punches
What is the purpose of the pendulum
Regains ROM
Phase 2 ROM
Stabilization Balancing Pushups Tubing Stretching Strengthening
Types of balancing for phase 2 rehab
Vibe plate
Dot drill
Types of stretching for phase 2 rehab
Corner (pec maj)
Sleeper
Posterior/anterior deltoid
Triceps
Types of strengthening for phase 2
I’s, Y’s and T’s with weight
Ceiling punch with weight
Rhomboid row with weight
Phase 3 rehab
Plyometrics Strengthening Pushups Tubing Balancing
Examples of plyometrics
Pushups
Trampoline
Catch and throw medicine ball
Strengthening for phase 3 rehab
I’s, Y’s, and T’s on ball with weight
Shoulder PNF
Ceiling punch
Pitching
Shrugs
Shiver
Ceiling punch
Resist protection and retraction
Pitching
Extended fingers, wrist, elbow, arm
Flex fingers, wrist and horizontal adduction across the chest
Shrugs
Athlete does a shoulder shrug up and down with arm in 90 degrees of elbow flexion, examiner resists
Shiver
Athlete is supine with elbow in 90 degrees of flexion and moved their arm in flexion and extension while examiner resists
Throwing analysis steps
Windup Cocking Acceleration Release-Deceleration Follow through
Prepares the body posture and balance in preparation of the cocking phase
Phase starts when the ball leaves the glove
Key concept is balance
Windup
Shoulder abduction and extension, scapula retracted
Throwing arms is fully externally rotated
Humerus parallel to the ground
Shoulder is still pointed at partner
Cocking
Very fast, explosive, short phase
Body brought forward with arm following behind
Opposite leg strides forwards
Elbow at or slightly above parallel
Acceleration
Majority of posterior shoulder pain comes from this phase
Elbow extends upon release
Arm 45 degree angle to body
Striding foot on the ground pointing at partner
Release-deceleration
Throwing shoulder goes across body
Full torso rotation over foot stride
Follow through
