return to function w/o pain funx training and restoration of ms imbalance address underlying causes (instability) address biomechanical faults Post op sling 3-4 weeks after 6 weeks - sport specific full recovery 3-4 months

Shoulder Conditions Flashcards by Kerry Allen

Anterior Glenohumeral Dislocation/Subluxation

95% of dislocations occur in anterior-inferior
Occurs when ABD UE is forcefully ER causing a tear of the inferior glenohumeral ligament, anterior capsule, and occasionally glenoid labrum

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Posterior Glenohumeral Dislocation/subluxation

posterior dislocations are rare and occur with multidirectional laxity of GH joint
Occurs w. horizontal ADD and IR of glenohumeral jt
Complications may include
- compression fracture of posterior humeral head (Hill-Sachs Lesion)
- tearing of superior glenoid labrum from anterior (front) to posterior (back) aka SLAP lesion.
- an avulsion of antero inferior capsule and ligaments associated w. glenoid rim (bankarts lesion)
- **bruising of axillary nerve **

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Glenohumeral Subluxation/Dislocation: Dx

plain film imaging, CT scan, MRI

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Glenohumeral Subluxation/Dislocation: PT

intervention varies depending on surgery
address biomechanical faults caused by joint restriction
restoration of normal shoulder mechanics via strengthening/endurance that focuses on scapulothoracic, glenohumeral, and muscular re-ed

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Glenohumeral Instability: Types and Characteristics

Traumatic: young throwing athletes
Atraumatic: individuals w/ congenitally loose connective tissue around the shoulder
Characteristics:
- popping/clicking and repeated sublux/dislocation of GH
Unstable injuries require surgery to reattach labrum to glenoid
**Bankharts lesion requires surgery

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Glenohumeral Instability: Dx

clinical exam comparing results of patient history with AROM, PROM. resistive tests and palpatation
MRI arthrograms are also very effective

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Glenohumeral Instability: PT

emphasize RTF w/o pain
functional training and restoration of ms imb
address biomechanical faults
Post surgery:
- should kept in sling for 3-4 weeks
- after 6 weeks: more sport specific training
- Full fitness may take 3-4 months

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Labral Tears: Etiology

Inferior or Superior, SLAP or Bankharts
Often occur with other shoulder pathology including dislocations

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Labral Tears: Signs and Symptoms

shoulder p! that cannot be localized to a specific point
p! made worse by OH activities or when arm is behind back
weakness
instability of the shoulder
p! on resisted flexion of the bicep (against resist elbow flex)
tenderness on the front of the shoulder

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Labral Tears: Diagnosis

clinical exam by comparing results of AROM, PROM, resist tests, and palpation.
MRI arthrograms
Arthroscopic surgery = GOLD STANDARD

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Labral Tears: PT

return to function w/o pain
funx training and restoration of ms imbalance
address underlying causes (instability)
address biomechanical faults
Post op
- sling 3-4 weeks
- after 6 weeks - sport specific
- full recovery 3-4 months

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Thoracic Outlet Syndrome:

compression of the neurovascular bundle
- brachial plexus
- subclavian artery/vein
- vagus/phrenic nerves
- sympathetic trunk
compression occurs when size/shape of TO is altered
Common areas of compression
- superior thoracic outlet
- scalene triangle
- between clavicle and 1st rib
- between pec min and thoracic wall

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Thoracic Outlet Syndrome: Dx

plain film imaging to identify bony abnorm
MRI identify soft tissue
Electrodiagnostic test - nerve dysfunc
CLinical exam
- adsons
- roos test
- wright test
- costoclavicular test

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Thoracic Outlet Syndrome: PT

**Surgery may be required to remove cervical rib or release ant/middle scalene
postural re-education
functional training and restoration of ms imb
biomechanical faults
manipulations (typically 1st rib articulation) to diminish pain and soft tissue guarding

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Acromioclavicular and Sternoclavicular Joint Disorders:

MOI: fall on shoulder w/ UE ADD or a collision with another individual during sporting event
Degree of injury graded I-III (IV-VI)
Acute phase:
- UE positioned in neutral w. use of sling
- avoid shoulder elevation

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Acromioclavicular and Sternoclavicular Joint Disorders: Diagnosis

plain film

Acromioclavicular and Sternoclavicular Joint Disorders: PT

surgical repair is rare second to tendency for AC joint degeneration afterward
emphasize RTF w/o pain
functional training and muscle imb
MT to AC and SC joints and surrounding connective tissue such as soft tissue massage/ joint oscillations etc

Subacromial/Subdeltoid Bursitis

both bursae have a close relationship to rotator cuff tendons making them susceptible to overuse and impinged below acromial arch

Subacromial/Subdeltoid Bursitis Dx

clinical examination - differentiate from contractile condition by comparing results of AROM, PROM and resistive tests

Rotator Cuff Tendonosis/Tendonopathy:

RTC tendons are susceptible to tendonitis due to relatively poor blood supply near insertion of ms

results from mechanical impingement of the distal attachment of the RC on the anterior acromion and/or coracoacromial ligament w/ rep OH activities

Rotator Cuff Tendonosis/Tendonopathy: Dx

MRI but not always sensitive enough
Clinical Exam
- supraspinatus test
- neer’s impingement

Impingement Syndrome:

Soft tissue inflam of the shoulder from impinge. against** acromion w/ rep OH AROM **

Impingement Syndrome: Dx

Arthrogram or MRI
Clinical exam
- neers
- supraspinatus
- drop arm test

Impingement Syndrome: PT

surgical repair - avoid shoulder elevation greater than 90
restoration of posture
correction of ms imbalance
biomechanical fault correction

Internal (Posterior) Impingement:

* irritation b/t the _RTC and greater tuberosity_ or _posterior glenoid & labrum _ * Seen most often in OH athletes * p! noted in posterior shoulder

Internal (Posterior) Impingement: Dx

clinical exam - posterior impingement test

Bicipital Tendonosis/Tendonopathy:

* most common- inflam of long head biceps * results from mechanical impingement of the proximal tendon, b/t anterior acromion and bicepital groove of humerus

Bicipital Tendonosis/Tendonopathy: Dx

MRI and Speeds Test

Proximal Humeral Fractures:

* Humeral Neck fractures: * occur w/ fall onto outstretched UE among older osteoporotic women * generally do not require immobilization or surgical repair (stable fracture) * Greater Tuberosity fx are * more common in middle-aged and elder * related to fall on shoulder, no immob rq

Proximal Humeral Fractures: Dx

plain film imaging

Proximal Humeral Fractures: PT

* return of fnx w/o pain * functional training and restoration of ms imbalance using exercise to normal ms * biomechanical faults * EARLY PROM IS IMPORTANT TO PREVENT CAPSULAR ADHESIONS

Adhesive Capsulitis:

* Characterized by restriction in motion as a result of **inflammation/fibrosis of shoulder capsule usually due to disuse** following injury or rep microtrauma * Commonly associated w/ DM * Capsular Pattern of Limitation * \>\>\>ER * \>\>ABD * \>Flex

Adhesive Capsulitis: Dx

clinical exam

Adhesive Capsulitis: PT

* RTF w/o p! * functional training and restoration of ms imbalance * biomechanical faults