Shoulder Flashcards
Med/Lat Pec
pec major C5-T1 pec minor (med only) C8-T1
Thoracodosral
lats
C6-C8
Axillary
deltoid, TMinor
C5-C6
Suprascapular
RTC
C5-C6
Musculocutaneous
coracobrachialis
C5-C6
Spinal Accessory
trap
CN XI
Dorsal Scapular
rhomboids, LS
C5
Long Thoracic
SA
C5-C7
Special Tests - instability/laxity
load and shift - A/P instability sulcus - MDI A/P draw - A/P lax apprehension (crank) - shoulder instability Fowler's Sign - ant GH instab
Passive Stabilizers
superior GH lig - prevents inf HH sublux (limits ER 0 deg abd)
middle - limits ant trans 45 deg abd
inf - 3 bands (post, inf, ant)
post capsule - blends with RTC, enhances stab
Special Tests - RTC/Impingment
possible RTC tear - empty/full can, ER lag sign, DA, belly press
impingement - HK, neer
Special Tests - Labral
SLAP - biceps load, compression/rotation
labral involvement - crank
Obrien’s - slap vs ac involvement
Special Tests - Biceps
Yergason’s - biceps tendon irritation
Speed’s - LH pathology, may indicate SLAP
Ludington’s - biceps rupture
Imaging
trauma - axillary, Y view scap, AP
non trauma - routine axillary
US good for RTC full thickness
west point/striker - bankart and hill sach’s
zanca - AC jt
Clavicular Fx (CET)
C - FOOSH, direct impact (most common in sports)
E - tilt head toward affected side with chin toward unaffected side, tender, possible deformity
T - sling/swath, immob 6-8 wks, sometimes surgery
Scapular Fx (CET)
C - direct impact or force through humerus
E - swelling, pt tender
T - sling 3 weeks
Humerus Fx (CET)
C - FOOSH, dislocation, direct blow
E - pain, inability to move arm, swelling
T - splint and immediate referral (shock possible), shaft 3-4 mo, prox 2-6 mo
SC Jt Sprain (CET)
C - blow to clavicle, torsion of post ext arm (not very common)
E - swelling, possible displacement, pt tender
T - RICE, reduction if necessary, immob 3-5 wks
AC Jt Sprain (CET)
C - direct impact to tip of shoulder, FOOSH on add/part flex arm
E - pain, tender, deformity > grade III
T - I (sling 2-4 days) II (sling 10-14 days) III (sling 2-3 weeks) IV+ (surgery)
AC Jt Sprain Grades
I - mild sprain of AC/CC lig II - complete tear of AC, CC sprain III - complete tear AC/CC IV - complete tears, clavicle separation V - clavicle goes through trap VI - clavicle locker under coracoid process
RTC Tear (CEST)
C - trauma in younger pop, degeneration in older pop
E - nigh pain, weak, tender
S - cluster (DA, painful arc, infra)
T - conservative for partial or older, surgery
RTC Repair
days 1-6
- abd brace until wk 6, PROM to 110, ER/IR in scap plane < 30
wk 2-7
- PROM to tol, scap iso, begin walking/bike for aerobics
wk 7-12
- initiate AAROM, DC brace, full PROM by wk 8, periscap ex, GH rhythmic stab
- initiate AROM when ROM WFL (no shrug)
wk 12-18
- full AROM by 12-14 wks, dynamic shoulder stab and strengthening, gradual return to fxnl activities
- wk 16 - low level plyo
wk 18 - light sports
wk 24 - interval sports program
Anterior Instability
occurs after trauma in ER/abd
higher risk for bankart and SLAP
90% of all dislocation
Posterior Instability
2-10% dislocations
higher risk of posterior labral tear
MDI
not usually associated with traumatic events
may result in recurrent sublux or dislocations
Anterior Stabilization
wk 1-3
- sling at all times, isos at wk 3
wk 4-5
- continue use of sling, PROM (caution with ER/abd)
wk 6-7
- wean from sling, full PROM, start AROM, isotonic/RS for RTC
wk 8-12 - progress
wk 12-16 - golf and tennis (serve at 4 mo), weight lifting (low weight, high reps)
wk 16-20 - interval sports program
SLAP Tear (CEST)
C - FOOSH, dislocation, peel back lesion from throwing
E - feeling on instability popping, dec throwing power
S - Obrien’s, biceps load, clunk
T - arthroscopic most common
SLAP Types
I - degenerative fraying of sup labrum, biceps attachment intact
II - biceps anchor has pulled away from attachment at glenoid
III - bucket handle tear of sup labrum with intact biceps anchor
IV - similar to III but extends into biceps anchor
I/III - debride, II/IV - repair
SLAP Repair (II/IV)
day 1-wk 2
- sling 4 weeks, no AROM (PROM/AAROM), no biceps contractions, submax iso RTC
wk 3-4
- DC sling, RS exercise, continue PROM/AAROM
wk 5-6
- initiate AROM, PNF shoulder, no resisted biceps
wk 7-9
- begin isotonics, Throwers 10, submax painfree iso biceps
wk 10-12
- continue TT, resisted biceps 12 weeks
wk 12-14
- light, restricted sports (light swimming, half golf swing), light plyo
wk 16-20 - interval sports training progarm
mo 6-9 - RTS accordingly
Bankart Lesion (CET)
C - most common with anterior shoulder dislocation (often accompanied by Hill Sach’s)
E - feeling of instability, popping, dec throwing power
T - arthroscopic
Arthroscopic Bankart Repair
wk 0-6
- sling for 3-4 wks, PROM/AAROM, AROM 4-6 wks, submax sho isos at 4-6 wks
wk 6-12
- full AROM by 10-12 wks, isotonics, RS
wk 12+ - begin plyos, sport specific exercises
wk 20-24 RTS
mo 6-9 - RTS accordingly
AC Jt Osteolysis (CET)
C - repetitive microtrauma, subchondral microfx overtime, heavy weight lifting (bench press, OH press inc incidence)
E - localized pain, swelling, weakness, (+) cross body add test, pain with resisted flex, crepitus
T - activity modification, allow for new bone formation, anti-inflammatories
