Shoulder-Clavicle-Brachial Disorders Flashcards
Bones & Joints of the Shoulder
Clavicle Sternum Scapula Humerus Ribs SC joint AC joint Glenohumeral joint Scapular thoracic joint
Muscles of the Shoulder
Supraspinatus Infraspinatus Subscapularis Teres minor Pectorals major Biceps Deltoid Trapezius Serratus anterior Rhomboid
Types of Conditions of the Shoulder
Traumatic Overuse Instability Fractures Age related processes Nerve injuries
What is AC separation typically a result of?
Falling directly on the tip of the shoulder
Hockey player getting checked into the boards
Describe Grade 1 AC Separation
Strain of the acromioclavicular ligament
Describe Grade 2 AC Separation
Tear of acromioclavicular ligament
Describe Grade 3 AC Separation
Tear of acromioclavicular & coracoclavicular ligaments
Clinical Findings with AC Separation
Tenderness at AC joint Possible deformity at AC joint Pain with adduction \+ cross arm test \+ Paxinos test Pain with doing a dip
Treatment of AC Separation
Rest
Ice
NSAIDs
Sling for comfort
Weaver-Dunn procedure- reconstruction of CC ligament
Return to activity: when patient is comfortable
MOI of a Clavicle Fracture
Falling directly on the tip of the shoulder
Hockey player getting checked into the boards
Clinical Findings with Clavicle Fracture
Tenderness to palpation
Pain with adduction
Patient sitting with shoulders rolled forward
Deformity at fracture site
Treatment of Clavicle Fractures
Rest Ice NSAIDs Sling for comfort Surgery: significant displacement Return to activity: 8 weeks
Rotator Cuff Tendonitis
Overuse injury
Result of inability to train appropriately
Result of a “weekend warrior”
What is happening internally with rotator cuff tendonitis?
Inflammation of cuff tendon
Degenerative fraying
Bursitis
Clinical Presentation of a Rotator Cuff Tendonitis
Pain after an aggravating activity
Pain can be insidious without specific injury
Localized to anterior/lateral shoulder
Pain worse with reaching overhead/behind the body
Pain at night/difficulty sleeping
Clinical Exam Findings for a Rotator Cuff Tendonitis
Tender to palpation Painful arc of motion/elevation Full ROM Pain with resisted supraspinatus testing No weakness \+ Hawkins \+ Neers
Treatment of Rotator Cuff Tendonitis
6 weeks of rest
Graduated throwing program
PT for strengthening
Subacromial steroid injection
Risk Factors for a Rotator Cuff Tear
Smoking
Age
Fall
Which rotator cuff muscles are most commonly torn?
Infraspinatus
Supraspinatus
How is the subscapularis generally torn?
Trauma
Clinical Presentation of a Rotator Cuff Tear
Pain with reaching overhead Nocturnal pain Can't get comfortable lying on shoulder Weakness Pain over anterior/lateral shoulder Pain radiates to deltoid tuberosity Pain insidious or sudden May have felt pop at time of injury
Clinica Exam Findings of a Rotator Cuff Tear
Tender to palpation Painful arc of motion/elevation Full passive ROM Pain with resisted supraspinatus testing Weakness \+ Hawkins \+ Neers Belly compression test Lift off test Bear hugger test
If there is weakness with external rotation, what is the probable muscle that is torn?
Infraspinatus
If there is weakness with empty can test, what is the probable muscle that is torn?
Supraspinatus
If there is weakness with internal rotation, what is the probable muscle that is torn?
Subscapularis
Treatment of a Rotator Cuff Tear
Rest Ice NSAIDs PT for strengthening Subacromial steroid injection MRI to determine size of cuff tear Surgical repair
Define Calcific Tendonitis
Deposition of calcium “hydroxyapatite” in the rotator cuff tendon
Which phase is calcific tendonitis more painful & inflammatory?
Liquid or tooth paste phase
Clinical Presentation of Calcific Tendonitis
Insidious or sudden
“White knuckle pain”
Pain with any movement of shoulder
Unable to sleep
Clinical Exam Findings of Calcific Tendonitis
Tenderness over greater tuberosity Limited AROM due to pain Pain with firing of the rotator cuff Full PROM Weakness of cuff due to pain
Treatment of Calcific Tendonitis
Rest Ice NSAIDs PT to prevent stiffness Subacromial steroid injection with needling of calcium deposit Surgical decompression & debridement
Define Adhesive Capsulitis (Frozen Shoulder)
Loss of motion of the shoulder as a result of tightening & shrinking of the shoulder capsule
Risk Factors for Adhesive Capsulitis (Frozen Shoulder)
Female
Diabetic
Hypothyroidism
3 Phases of Adhesive Capsulitis
Freezing
Frozen
Thawing
Clinical Presentation of Adhesive Capsulitis
Insidious onset Progressive loss of motion May follow trauma, but idiopathic Pain at end of ROM Nocturnal pain Can't reach into back pocket
Clinical Exam Findings of Adhesive Capsulitis
Loss of PROM & AROM
Pain at end of ROM
Treatment of Adhesive Capsulitis
PT to work on capsular stretching
Glenohumeral steroid injection to decrease inflammation
Manipulation under anesthesia
Arthroscopic capsular release
What populations are labral injuries common?
Overuse: throwers
Traumatic: football, wrestling, volleyball, tennis
Define a Labral Injury
Injury to soft tissue cartilage ring around socket of the shoulder which provides stability
Clinical Presentation of a Labral Tear
Painful pop in shoulder
Difficulty throwing a ball
Mild sense of instability
Clinical Exam Findings in a Labral Tear
Full ROM
Crepitus with internal/external rotation
+ O’brien test
Treatment of a Labral Tear
PT for rotator cuff strengthening & stabilization
Surgical repair if persistent pain
Treatment of Impingement Problems
Aggressive stretching program for anterior capsule
Strength program for the rotator cuff
Which dislocation is more common, anterior or posterior?
Anterior: elevation & external rotation
When is a posterior dislocation more common?
Seizure
Electrocution
Football lineman
MVA
Clinical Presentation of an Anterior Dislocation
Pain following injury
1st time: reduction & early immobilization
PT for strengthening & stabilization
Clinical Exam Findings of an Anterior Dislocation
+ Apprehension sign
+ Relocation test
Increase anterior translation
Pain with ROM & guarding with reaching overhead
Treatment of Anterior Dislocation Treatment
X-ray to rule out glenoid fracture
X-ray for Hillsach’s deformity
PT for strength & stability
Return to play: 4-6 weeks
Treatment with Recurrent Dislocations
Surgery
Treatment of Posterior Dislocation
Reduce & immobilization
PT for strengthening
Bracing
Which population are the worst offenders for shoulder multidirectional instability?
Wrestlers
Volleyball players
Presentation of Shoulder Instability
+/- multi-joint laxity
Report recurrent shoulder dislocation without ER visits
Dull ache in the shoulder
Treatment of Shoulder Instability
PT to strengthen scapular stabilizers & rotator cuff
Surgery: last option
Risk for OA of the Glenohumeral Joint
Previous trauma Dislocations Instability issues Hereditary Heavy laborer
Clinical Presentation of Glenohumeral OA
Insidious onset of shoulder pain
Loss of ROM
Pain at end of ROM with sudden movement
Clinical Exam Findings with Glenohumeral OA
Loss of ROM especially internal/external rotation Normal strength Crepitus Cogwheeling Tender of anterior/posterior capsule
Treatment of Glenohumeral OA
NSAIDs, Tylenol Terminal stretching Glucosamine/Chondrotin Activity modification Steroid injection Total shoulder replacement
Define Parsonage Turner Syndrome
Inflammation of a network of nerves that innervate the muscles of the chest, shoulders & arms
Clinical Presentation of Parsonage Turner Syndrome
Severe pain across shoulder & upper arm
Weakness
Atrophy
Paralysis of shoulder muscles
Clinical Exam Findings of Parsonage-Turner Syndrome
Atrophy of supraspinatus & infraspinatus
Significant weakness of affected muscles
Non-tender
May not tolerate palpation
Treatment of Parsonage Turner Syndrome
EMG studies MRI Oral steroids Neurontin Pain medication PT
Other Shoulder Injuries
Stinger/brachial plexus traction injury Proximal humerus fracture Scapular fractures Long thoracic nerve injury "scapular winging" OA of AC joint Long head biceps rupture Spinoglenoid cyst
Prevention of Shoulder Injuries
Strengthening
Stretching
Supraspinatus Exercises
Empty can test with thumb down
Light dumbbells or rubber tubing
Infraspinatus & Teres Minor Exercises
Place elbow at side
Externally rotate against resistance
Subscapularis Exercises
Elbow at side
Internally rotate against resistance
