shoulder and elbow injuries Flashcards
why is the shoulder prone to injury?
because of its excessive movement in multiple directions
what is the only bony connection from the axial skeleton to the appendicular skeleton?
the sternoclavicular joint
what are the four muscles that make up the rotator cuff?
supraspinatus, infraspinatus, subscapularis, teres minor
what are 3 prevention strategies that lessen the risk of shoulder/elbow injuries?
1) strength and conditioning
- strengthening
- flexibility
- proper dynamic warm ups
2) use proper technique
- training - how to fall (FOOSH)
- training - how to take/give a hit
3) protective equipment
- pads: shoulder/elbow
what are the three types of humeral fractures?
1) humeral shaft
2) proximal humerus
3) epiphyseal
humeral shaft fracture MOI
direct blow or FOOSH
- communicate or transverse fracture
- deformity
what is a possible complication of a humeral shaft fracture?
radial nerve paralysis - wrist drop and inability to supinate forearm
proximal humerus fracture - MOI
direct blow, FOOSH, or GH dislocation
where is the proximal humerus fractured most of the time?
at the surgical neck
-can also involed tubercles or anatomical neck
what is a possible complication of a proximal humerus fracture?
danger to nerve and blood vessels
epiphyseal fracture of the humerus is most frequent in which population
individuals under 10
epiphyseal fracture of the humerus - MOI
direct or indirect blow
S&S of epiphyseal fracture of the humerus
shortening of arm, disability, swelling, point tender, and pain
management of humeral fractures
- splint, sling, and swathe
- treat for shock
- refer to physician (xray diagnosis)
- immobilization
what is the most frequent fracture in sports?
clavicle fracture
most fractures occur in the ____ third of the clavicle
middle
MOI - clavicle fracture
FOOSH, fall on tip of shoulder or direct impact
S&S of clavicle fracture
- patient supporting arm with head tilting towards injured side
- upward displacement of the medial clavicular segment (pull of the SCM)
- pain and deformity on palpation
management of clavicle fracture
- sling and swathe
- monitor distal MSC (clavicle fracture is an urgent situation if MSC not present)
- treat for shock
- refer to hospital
- immobilized in figure 8 splint for 6-8 weeks or operative management
glenohumeral dislocation is an extremely common injury and is recurrent ___% of the time
85-90
the majority of glenohumeral dislocations are ______ (direction)
anterior/inferior
MOI - glenohumeral dislocation
impact to the posterior/posterolateral shoulder
-forced abduction, external rotation and extension
S&S of glenohumeral dislocation
- flattened deltoid
- head of humerus palpable in axilla
- carries affected arm in slight abduction and external rotation (one test: try to get person to touch their other shoulder)
- unable to touch opposite shoulder
- moderate pain and disability
extensive soft tissue damage with dislocation
- torn capsule and ligaments
- possible tendinous avulsion of rotator cuff or long head of biceps
- possible injury to brachial plexus
- profuse hemorrhage
what are 3 common lesions associated with glenohumeral dislocation
1) Bankart lesion
2) Hill-Sachs lesion
3) SLAP lesion (superios labrum anterior/posterior)
Bankart lesion
tear of the anterior (inferior) glenoid labrum
-bony bankart include fracture to the anterior (inferior) glenoid cavity
Hill Sachs lesion
- defect on the posterior lateral aspect of the humeral head
- engaging and non-engaging
SLAP lesion
- tear of superior aspect of the labrum that start posteriorly and extends anteriorly
- affects attachment of LH biceps
management of glenohumeral dislocation
- sling with padding under arm
- ice to control hemorrhage
- immediate referral to physician
- 1st time: xray required prior to reduction to rule out fracture
- recurrent: physician may attempt to relocate on field
- immobilization for 3 weeks
- can perform isometric exercises for rotators
- muscle reconditioning following immobilization (stabilize joint) (strength in abduction position)
biceps brachii tenosynovitis is common in which population?
individuals engaged in overhead activities
biceps brachii tenosynovitis - def
irritation of tendon and synovial sheath as it passes under transverse humeral ligament in the bicipital groove
-constant inflammation may result in degenerative scarring (tendinosis) or rupture of ligament (subluxation)
S&S of biceps brachii tenosynovitis
- tenderness over bicipital groove
- swelling, warmth, and crepitus
- pain with overhead dynamic throwing activities
management of biceps brachii tenosynovitis
- complete rest
- ice and or ultrasound to address inflammation
- gradual progress of stretching and strengthening
shoulder impingement - def
compression of the supraspinatus tendon, subacromial bursa, and LH of biceps under the coraco-acromnial arch
- due to repetitive overhead activities or failure of RC muscles to maintain position of humeral head
- often leads to irritation and inflammation (can lead to rupture of the supraspinatus or biceps tendons)
which muscle is often associated in a rotator cuff tear?
- most often supraspinatus, due to trauma or impingement
- almost always at insertion on the greater tubercle
full thickness rotator cuff tears are twice as likely as partial thickness tears
true or false?
false, vice versa
who is most prone to a full thickness rotator cuff tear?
chronic shoulder injury individuals over 40 YOA
shoulder impingement - cause
- poor posture, forward head, rounded shoulders, and increased kyphotic curve
- hook shaped acromion process (intrinsic factor)
S&S of shoulder impingement
- diffuse pain around acromion
- stiffness
- pain on palpation of subacromial space
- ROM and strength or RC muscle affected
- increased GH external rotation (ERG)
- decreased GH internal rotation (GIRD)
- external rotators weaker than internal rotators
what are two special tests for shoulder impingement
- Neer and Hawkins-Kennedy
- supraspinatus tear - empty can
painful arc at 80-120 abduction
management of shoulder impingement
- POLICE to reduce inflammation
- restore normal biomechanics
- strengthen RC muscles
- core exercises
- GH joint mobilizations
surgical intervention:
-subacromial decomposition (shaving acromion process)
adhesive capsulitis (frozen shoulder) - def
contracted and thickened joint capsule with little synovial fluid
- cause unclear
- typically older individuals
- rotator cuff muscles also contracted and inelastic
S&S of adhesive capsulitis (frozen shoulder)
- pain in all directions of shoulder movement
- extremely limited AROM and PROM of all GH motions
management of adhesive capsulitis (frozen shoulder)
- aggressive stretching and joint mobilization
- pain relief with electrical modalities
thoracic outlet syndrome
compression of the brachial plexus, subclavian artery, and subclavian vein (neurovascular bundle) in the neck and shoulder
the compression in thoracic outlet syndrome is due to which 4 things?
1) narrow space between 1st rib and clavicle
2) between anterior and middle scalenes
3) pectoralis minor muscles as bundle passes under coracoid process
4) presence of additional cervical rib
S&S of thoracic outlet syndrome
- paresthesia and pain
- sensation of cold
- impaired circulation in fingers
- muscle weakness and or atrophy
- radial nerve palsy
what are 4 special tests for thoracic outlet syndrome
1) Adson’s test
2) Military brace
3) Roo’s test
4) Allen test
management of thoracic outlet syndrome
- stretch pectoralis minor and scalene muscles
- strengthen trapezius, rhomboids, serratus anterior, and erector spinae
- if conservative treatment fails, may need to surgucally release anterior scalene or remove 1st rib
ulnar collateral ligament sprain - MOI
- result of repetitive valgus loading on elbow (late cocking and early acceleration phase of throwing; forehand tennis stroke; trailing arm during improper golf swing)
- mechanics may also result in ulnar nerve inflammation or tendinosis of wrist flexor tendons (medial epicondylitis)
S&S of UCL sprain
- pain along medial elbow
- tenderness on UCL distal insertion
- valgus stress test positive (pain and laxity)
management of UCL sprain
conservative:
- rest and NSAIDs
- strengthening
- correct faulty mechanics
operative:
- common among high level pitchers “Tommy John Surgery”
- palmaris longus autograft and possible transposition of ulnar nerve
- recovery takes about 18-24 months
medial epicondylitis “golfer’s elbow” - def
degenerative changes in the tendons that originate from the medial epicondyle (wrist flexors)
-in young athletes, growth plate involvement = “little league elbow”
MOI - medial epicondylitis
- repetitive valgus forces during acceleration phase of throw/swing
- repetitive overuse of wrist flexor muscles
- golfers using too much wrist flexion in trailing arm
- baseball pitchers throwing curveball or screwball
- forehand stroke in racket sports
- throwing a javelin
S&S of medial epicondylitis
- pain on medial epicondyle, esp with wrist flexion and pronation
- pain radiating down forearm (ulnar nerve)
- point tender on palpation
- mild swelling
management of medial epicondylitis
- POLICE
- brace - chopat or golfer’s elbow strap
- referral to physician - meds, NSAIDs, or pain relievers
- therapy - modalities, friction massage, stretching and strengthening extensors
what are the four factors that usually contribute to cubital tunnel syndrome?
1) traction injury due to valgus torque
2) irregularities within the cubital tunnel
3) subluxation due to ligament laxity
4) progressive compression due to the ligament
S&S of cubital tunnel syndrome
- pain on medial aspect of elbow - may radiate proximally or distally
- tenderness on palpation of cubital tunnel
- intermittent paresthesia, burning, and tingling in 4th and 5th digits
management of cubital tunnel syndrome
- conservative: rest and immobilization (avoid hyperflexion and valgus stresses, NSAIDs)
- surgical decompression or transposition of ulnar nerve (move nerve medially)
olecranon bursitis - MOI
- acute: direct blow or fall on elbow
- chronic: constant leaning on elbow or repetitive friction
- differential diagnosis: infection, rheumatoid arthritis, or gout
S&S of olecranon bursitis
- pain, severe swelling, and point tenderness
- occasionally swelling without pain or heat
management of olecranon bursitis
- POLICE - primarily with compression
- aspiration may be required if swelling persists
elbow dislocation - MOI
- FOOSH with elbow hyperextended
- severe twist while elbow flexed
- most commonly ulna and radius forced backward (posterior dislocation) - olecranon extends posteriorly while medial and lateral epicondyles are aligned
S&S of elbow dislocation
- obvious deformity
- profuse hemorrhage and swelling
- severe pain and disability
- complications include UCL sprain, radial head fracture, injury to median and radial nerves and arteries
elbow dislocation management
- POLICE
- splint and sling for immediate referral to physician
- joint reduction
- immobilized in flexion
- perform gentle hand gripping and shoulder exercises, while maintaining flexion immobilization
-aggressive ROM or exercises prior to initial healing = high probability of myositis ossificans
elbow dislocation: Nursemaid elbow
- common in preschool-aged children
- MOI: pull along longitudinal axis of forearm - swinging or picking up child from wrist
- due to laxity in annular ligament
S&S of Nursemaid elbow
- pain moving elbow
- child will hold arm still at side
- refuse to bend the elbow or use the arm
management of nursemaid elbow
reduction by physician
