Shoulder Separation Lowe Flashcards
What is Shoulder Separation?
-sprain to the ligaments of the acromioclavicular or coracoclavicular joints
Characteristics:
caused by shoulder being struck by a falling object or falling directly on the shoulder; stabilizing ligaments of the AC joint are sprained
acromioclavicular ligament: stabilizes the AC joint
conoid and trapezoid ligament (coracoclavicular): stabilize the clavicle and coracoid process of the scapula
-AC ligament usually injured but more severe injuries include the CC ligament complex
-mild to severe deforming condition; categorized into three types
Type 1: incomplete tearing of AC ligament, joint capsule and CC ligaments remain intact, does
not create physical change in the structures
Type 2: complete tear of AC ligament and joint capsule, may involve some stretching or tearing
of CC ligament; clavicle may become misaligned, results in more pain
Type 3: complete tear of AC ligament, joint capsule and significant damage to CC ligaments; pain and loss of stability; significant alteration of clavicle position, can displace and cause tearing or detachment of deltoid or trapezius causing obvious structural disfiguration; can force the distal clavicle inferiorly so it approximates the first rib producing a bulge; refer for further evaluation
-falls or impacts can cause sprain/dislocation to sternoclavicular joint; not as common but serious because dislocation of proximal end of clavicle can cause pressure or rupture to trachea or jugular vein
-if clavicular disruption has compressed brachial plexus, patient may report pain, numbness, paresthesia or weakness in upper extremity
History:
sudden traumatic injury to lateral shoulder; sharp intense pain at time of injury, ligament damage causes tenderness, pain during various movements, night pain
Observation:
may be visible swelling; capillary rupture causes bruising, dislocation of distal clavicle, pronounced bump or divot at AC joint; movement restrictions and apprehension due to pain
Palpation:
AC joint painful; depends on severity of injury; distal clavicle may be mobile due to ligament damage; excess movement if fibrous scar tissue has not developed
Range of Motion and Resistance Testing
AROM: painful in flexion, abduction or horizontal adduction; place stress on AC joint and CC ligaments;
movement restriction and decreased ROM due to pain avoidance
PROM: as with AROM
MRT: no pain of performed near neutral shoulder position; may be pain if deltoid, trapezius or pectoralis major (attach to clavicle) are involved as they pull the clavicle and stress damaged ligaments; painful and weak if trapezius or deltoid are torn or detached
Special Tests:
Cross Over: standing/seated; therapist brings arm into full horizontal adduction to evaluate pain reproduction; if primary complaint is reproduced, positive test; perform test passively to minimize patient’s discomfort; stresses the ligaments of the distal clavicle which are inert so active or passive will have same results
-when arm brought across chest in horizontal adduction, distal clavicle is pressed against acromion process and pushes against the edge of the acromion; if ligaments intact, prevent accessory motion at articulation; if damaged, tensile stress on resisting ligaments causes pain
Differential Evaluation:
glenoid labrum injury, subacromial bursitis, shoulder impingement, rotator cuff pathology, clavicular fracture, glenohumeral subluxation or dislocation, humeral or scapular fracture
Suggestions for Treatment:
reestablish stability in AC complex (arm sling); clavicle may heal in different position (aesthetic not functional impairment); deep friction to encourage collagen rebuilding in damaged ligaments (with severe tear, up to 72 hours after initial inflammatory phase); may delay longer with severe injury and consult with physician; massage and stretching to prevent spasm or development of capsular adhesions
