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Kin 371 (Athletic Injuries) > Week 13 - Shoulder > Flashcards

Week 13 - Shoulder Flashcards

1
Q

Shoulder facts?

A

The shoulder is an extremely complicated complex

  • High degree of mobility, but less stability
  • Involved in many overhead activities in sport, making it
    susceptible to repetitive and overuse injuries
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2
Q

Shoulder Observation?

A

Site
* Deformity, swelling, discolouration
* Limb positioning
* Elevation or depression of shoulder
tips (inferior angle of the scapula)
* Position and shape of clavicle
* Acromion process (step deformity)
* Biceps and deltoid symmetry
* Scapular elevation and symmetry
* Scapular protraction or winging
* Muscle symmetry
Look from front and back

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3
Q

Shoulder Gait?

A

Gait
* Asymmetrical arm swing
* Leaning toward painful
shoulder

Scapulohumeral Rhythm

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4
Q

Shoulder Posture?

A

Posture
* Postural assessment
(kyphosis, lordosis, shoulders)
* Rounded shoulders
* Position of head and arms
* Forward head posture

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5
Q

Shoulder Scapulohumeral Rhythm?

A
  • The scapula stabilizing muscles allow for proper joint motion,
    alignment, and stability
  • Movement of scapula relative to the humerus
  • First 30 degrees of glenohumeral abduction: no scapular movement
    (setting phase)
  • Above 30 degrees: scapula abducts and upwardly rotates 1 degree
    for every 2 degrees of humeral abduction
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6
Q

Shoulder Palpation?

A

Be aware of what you are palpating!
* Anatomy learned in lab
* If something hurts, think about what structure you are on
* Bony landmarks will help you localize ligaments and
tendon insertions
* Feeling for: swelling, heat, abnormality, muscle guarding,
trigger points (SHARP)

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7
Q

Glenohumeral Stability Load and shift Test?

A

Load and shift
* Translation of 1 cm or greater indicates glenohumeral
ligament instability

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8
Q

GHST Anterior and Posterior Drawer tests?

A

Increased translation/apprehension/pain indicates
anterior/posterior instability

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9
Q

GHST Apprehension Test?

A

Pain, apprehension indicates shoulder instability

Crank test

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10
Q

GHST Relocation test?

A

Pain diminishes (positive test)- indicates secondary
impingement (result of poor glenohumeral stability)

  • Pain remains (negative test)- indicates primary impingement
    (pain not dependent on arthrokinematics)
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11
Q

GHST Release test?

A

Pain with release (positive test) indicates secondary
impingement

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12
Q

Sulcus Sign Test?

A

Sulcus sign test
* Dip below acromion (positive
test) unilaterally indicates
inferior glenohumeral instability

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13
Q

Clunk Test?

A
  • Clunk test
  • Pain, grinding sound (positive test) indicates labral tear
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14
Q

O’Brian’s Test?

A

Pain with internal rotation,
diminished with external
rotation indicates SLAP lesion
* Superior labrum anterior
posterior

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15
Q

Yerganson’s Test?

A

Pain with resisted supination
indicates SLAP lesion, biceps
tendinitis

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16
Q

Clavicular Mobilization?

A

Clavicular mobilization
* Increased mobility indicates AC joint pathology

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17
Q

Impingement Tests (3)?

A

Neer’s Test
* Pain indicates subacromical
impingement
-

Hawkins-Kennedy Test
* Pain indicates subacromial
impingement

Empty Can Test
* Pain indicates subacromial
impingement

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18
Q

Drop Arm test?

A

Drop Arm Test
* Inability/difficulty maintaining
position indicates supraspinatus
tear

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19
Q

Speed’s Test?

A

Speed’s Test
* Pain in bicipital groove indicates
biceps pathology

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20
Q

Clavicular # MOI and S&S?

A

MOI = FOOSH
- Most common in the middle third

S&S = Sternocleidomastoid elevates proximal end and shoulder drops at distal end = deformity
Swelling quickly, TOP, ecchymosis
Patient support injured arm

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21
Q

Clavicular # Tx and Prevention?

A

Immediate Tx:
* Sling/splint, treat for shock
* Call EMS
* Immobilized 6-8wks
* Figure 8 brace
* Sling additional 3-4 weeks

Prevention:
* Properly fitting shoulder pads in contact
sports
* Educate on proper falling mechanics

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22
Q

Humeral # MOI and S&S?

A

MOI:
* Shaft: direct blow
* Comminuted or transverse
* Proximal humerus: FOOSH,
direct force
* Epiphyseal growth plate: < 10 years of age,
direct/indirect trauma

SSx:
* Pain, possible deformity, inability
to the arm, ecchymosis, swelling,
possible wrist drop and inability
to do supination (radial nerve
involvement)

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23
Q

Humeral # Tx?

A

Immediate Tx:
Treat for potential shock
* Splint or sling, treat for
shock
* Radiograph to confirm
* Nondisplaced: immobilized
6-8wks in sling
* Displaced: surgery (ORIF)
* Functional recovery in 2-6
months

Risk of developing frozen shoulder during immobilization

24
Q

Sternoclavicular Sprain (SC) MOI and S&S Grading (1-3)?

A
  • MOI:
  • Direct blow, anterior force
  • Indirect force along the long axis of the clavicle

SSx:
* Grade I: localized SC pain, TOP, slight disability

Grade II: pain, joint displacement, swelling, point
tenderness, decreased ROM (shoulder abduction, horizontal adduction)
* Partial tear of SC and costoclavicular ligaments

Grade III: gross deformity (dislocation), pain,
swelling, decreased ROM
* Full rupture to both SC, costoclavicular
ligaments
* Possibly life-threatening if dislocates posteriorly
* Difficulty breathing, swallowing, decreased
circulation, voice change

25
SC sprain Tx and prevention?
Immediate Tx: * POLICE, sling (Figure 8 brace) * EMS if posterior grade III sprain * Immobilize for 3-5 weeks followed by gradual reconditioning Prevention: * Direct blows difficult to prevent * Proper falling technique
26
AcromialClavicular Sprains MOI?
“Separated shoulder” * MOI: * Direct blow, upward force from humerus (FOOSH)
27
AC Sprains G1?
SSx (based on Rockwood classification) * Grade I: no disruption of AC joint * Point tenderness, pain with shoulder abduction, horizontal adduction
28
AC Sprain G2?
Grade II: tear or rupture of AC ligament, partial displacement of distal end of clavicle * Pain, point tenderness, decreased ROM (abduction, horizontal adduction)
29
AC sprain G3?
Grade III: rupture of AC and coracoclavicular (CC) ligaments Step Deformity * Significant superior displacement of distal clavicle * Pain, decreased ROM (abduction, horizontal adduction)
30
AC Sprain G4?
Grade IV: rupture of AC ligament * CC ligament may remain intact * Posterior clavicle displacement * Pain, decreased ROM
31
Ac Sprain G5?
Grade V: rupture of AC and CC ligaments, tearing of deltoid and trapezius attachments * Superior and posterior clavicle displacement * Gross deformity, severe pain, decreased ROM
32
AC sprain G6?
Grade VI: rupture of AC and CC ligaments, tearing of deltoid and trapezius attachments * Inferior displacement of clavicle behind the coracobrachialis tendon (rare) * Gross deformity, severe pain, decreased ROM
33
AC Sprain Tx and Prevention?
Immediate Tx: * POLICE * Sling, referral to physician * Grades I-III (non-operative): * 3-4 days to 2 weeks of immobilization * Grades IV-VI: surgery * Open reduction internal fixation (ORIF) Prevention: * Proper protective shoulder padding * Proper fall technique
34
Biceps Brachii Strain MOI + S&S?
MOI: * Long head of biceps strained with forceful muscle contraction * Usually eccentric contraction during follow through of throwing SSx: * Pain/weakness with active shoulder/elbow flexion and supination, pain with active/passive shoulder/elbow extension * Swelling, ecchymosis * Grade 3: Snap heard, sudden intense pain, muscle bulge with contraction (Popeye sign)
35
Biceps strain Tx and Prevention?
Immediate Tx: * POLICE, sling * Grade 3: Referral to hospital, possible surgery --> but not very often. Usually just strengthening muscles that do elbow flexion can compensate. Prevention: * Flexibility training * Correct biceps/triceps imbalances * Proper warm up
36
Shoulder Impingement MOI?
MOI: * Repetitive compression of the supraspinatus tendon (most common), long head of the biceps tendon and/or the subacromial bursa due to decreased subacromial space * Usually occurs with overhead activity * Associated with hypermobility, decreased capsular stability, weakness of rotator cuff muscles, poor scapulohumeral rhythm * Associated with hooked acromion and forward head posture/rounded shoulders
37
Shoulder Impingement S&S?
SSx: * Diffuse pain around acromion whenever arm is overhead * Painful arc between 70-120 degrees abduction * Affected areas (supraspinatus tendon, long head of biceps tendon) tender on palpation * Pain with side sleeping * Positive Neer’s, Hawkins-Kennedy * Positive Empty Can Test, Drop Arm Test (if supraspinatus tear) * Possible weakness of rotator cuff
38
Shoulder Impingement S&S for Neer's Classification Stage 1?
Occurs in patients <25 years old * Initial injury to supraspinatus or long head of biceps * Aching after activity, point tenderness over tendons * Pain during abduction (worse after 90 degrees), straight arm shoulder flexion, resisted supination with external rotation * Inflammation * Temporary thickening of rotator cuff and subacromial bursa * Possible atrophy and constriction of shoulder muscles Chronic Injuries
39
Shoulder Impingement S&S for Neer's Classification Stage 2?
Stage II: * Permanent thickening and fibrosis of the supraspinatus and biceps tendon and possibly subacromial bursa * Aching during activity (worse at night) * Decreased ROM
40
Shoulder Impingement S&S for Neer's Classification Stage 3?
Stage III: * Patients 25 – 40 years old * Hx of shoulder problems * Shoulder pain during activity, increased pain at night * Tendon defect < 1 cm * Possible partial muscle tear * Permanent thickening of rotator cuff and acromial bursa with scar tissue
41
Shoulder Impingement S&S for Neer's Classification Stage 4?
Stage IV: * Patients > 40 years old * Infraspinatus and supraspinatus wasting * Pain with abduction to 90 degrees * Tendon defect > 1 cm * Limited AROM, full PROM * Weakness with abduction and external rotation * Possible degeneration of clavicle
42
Shoulder Impingement Tx for Grades 1/2?
Tx (grades I and II): * POLICE, avoid aggravating motions (overhead) * Strengthen rotator cuff/scapular stabilizers * Increase neck flexibility, stretch pecs (correct posture/increase subacromial space) * Joint mobilization, myofascial release of scar tissue * Functional recovery in 2-6 weeks
43
Shoulder Impingement Tx for Grades 3-4?
Tx (grades III and IV): * Immobilization and complete rest * Possible surgery (subacromial decompression) - acromiaplasty
44
Bicipital Tenosynovitis/ Tendonistis - MOI and S&S?
MOI: * Overhead activities that cause ballistic stretching or repetitive overloading causes rubbing of the tendon on the transverse humeral ligament and traction at tendon attachment site SSx: * Bicipital groove TOP, swelling, warmth, possible crepitus, pain in anterior shoulder when throwing, subluxation of tendon may occur * Positive Yergensen’s, O’Brien’s, Neer’s, Hawkins- Kennedy, Speed’s tests
45
Bicipital Tenosynovitis/ Tendinistis Tx and Prevention?
Immediate Tx: * POLICE * Load management * Avoid aggravating activities * Gradual program of strengthening and stretching biceps * ECCENTRICS * Functional recovery in 6-8 weeks Prevention: * Strengthening biceps (eccentrics) * Proper training intensity progression * Strengthen rotator cuff and postural muscles
46
Adhesive Capsulitis MOI?
MOI: * Usually with older patients (no known cause) or following a shoulder injury that is not properly treated and rehabilitated * Immobilization or decreased movement for an extended period results in a contracted and thickened joint capsule * Rotator cuff muscles contracted and inelastic
47
Adhesive Capsulitis S&S?
SSx: * Pain and reduced ROM in all movements (especially flexion and external rotation) * Phase 1: increased pain and inflammation * Phase 2: pain, ROM limited by stiffness * Phase 3: reduced pain, but ROM severely limited due to stiffness
48
Adhesive Capsulitis Tx and Prevention?
Immediate Tx: * Phase 1: ROM in painfree range * Phase 2: Heat, ROM and stretching * Phase 3: Heat, aggressive stretching and joint mobilizations * Functional recovery 6-24 months AVG = 1 year Prevention: * Avoid prolonged immobilization
49
Rehab Considerations: Immobilization?
Varies depending on injury (can lead to a frozen shoulder)
50
Rehab Considerations: ROM?
Stretch - shoulder - Cervical, thoracic spine Passive & Active ROM Joint mobilization
51
Rehab Considerations: Strength/endurance?
Affected structures Scapular stabilization - serratus anterior - Lower and middle traps - Rhomboids Rotar Cuff - as a group and their individual actions
52
Rehab Considerations: Neuromsc Control?
Allows fro postural alignment, scapular stability - Joint loading - balance
53
Shoulder Injury Prevention?
Good msc balance Good Scapulohumeral Rhythm Dont just work mscs in mid range --> have strength in flx/ ext (full ROM) Warm up w/ dynamic warmup - Simulate athletic activity - Activate whole shoulder girdle Teach proper fall techniques Use protective equipment Teach mvm biomechanics to reduce overuse injuries
54
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Kin 371 (Athletic Injuries) (27 decks)

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