shoulderinjuries/ROM

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Scapulothoracic rhythm and humeral motion

for the humerus to be elevated to its maximal 180 degrees, the GH joint and the scapulothoracic articulation must work closely together

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___ratio of GH:ST motion  hence, 120 degrees GH joint motion and 60 degrees scapulothoracic motion- this ratio is not smooth or consistent

2:1

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early ROM is all __joint and scapula provides base of support

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intermediate ROM is more like ___ratio

1:1

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extreme ROM occurs at ___

GH joint

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ONCE YOU GET ABOVE___DEGREES, CLAVICLE ROTATES A DEGREE FOR EVERY DEGREE YOU RAISE YOUR ARM

30-40

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Passive ROM Abduction

inferior capsule- impingement

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Passive ROM flexion

posterior capsule- impingement

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Passive ROM extension

anterior capsule

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Passive ROM Internal / external rotation

infraspinatus, teres minor / subscapularis

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Passive ROM Horizontal adduction

posterior capsule, posterior rotator cuff/ anterior capsule, pects

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MOI AC joint sprain

fall on outstretched hand/arm or direct trauma to the tip of the shoulder driving the scapula under the clavicle

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ac joint sprain occur as Type I-VI joint sprains which is described___

by which and how much of each ligament tears as well as deformity

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ac joint sprain; S&S: deformity, point tenderness over the AC joint; pain with AROM above ___; positive __test Tx: referral; ____brace/sling

90 degreesSpring figure eight

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grade 1 ac joint sprain

partial tear of AC ligament and capsule

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grade 2 ac joint sprain

complete tear of AC lig and partial CC lig

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grade 3 ac joint sprain

complete tear of both AC and CC ligamentsPossible involvement of the trapezius and deltoid muscles

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SC Joint sprain mechanism

fall on outstretched hand/arm or direct trauma

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SC Joint sprain tx

referral; figure eight brace/sling

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SC Joint sprain s/s

point tenderness over the SC joint; pain with AROM above 90 degrees; positive Spring test

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GH Joint sprain moi

typically occur when forces are exerted at the end of ROM and often results in a Subluxation/dislocation

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GH Joint sprain s/s

general complaint of shoulder soreness; if labrum torn there is more localized pain with movement

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GH Joint sprain tx

treat symptomatically, rest, strengthening, referral prn

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shoulder stains cause

due to the mobility of the joint-capsule and ligamentous structures are comparatively lax – provide little stability

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__provide most of the stability (primarily the rotator cuff) and any of them can be injured

muscles

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2. Rotator Cuff SITS muscles  muscle test to see which is injured treat symptomatically and __

rehabilitate

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Clavicle:  fractures typically occur at the ___where the bone changes contour

distal one-third

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clavical fracture S&S: point tenderness; deformity; crepitus; positive ___

compression

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clavical fracture tx

TX: stabilize and refer

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humerus fracture possible MOI

 possible spiral fracture of the humeral shaft when torsional stress added

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humerus fracture s/s

S&S: severe pain and point tenderness; swelling, disability; deformity

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potential complication of humeral shaft fractures is ____

possible involvement and injury to the radial nerve

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anterior dislocation

humeral head lodges between the anterior glenoid rim and the coracoid process

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s/s anteior dislocation

arm slightly abducted and supporting the injured arm: the acromion process will be prominent; flattened deltoid appearance; possible palpation of the humeral head in the in the axilla; unwillingness of the athlete to move the extremity

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concern w/ anterior dislocation

concern with the axillary nerve

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Posterior: -less frequent than anterior- occur when :

the arm is forward flexed and a posterior force is applied along the length of the humerus which drives the humeral head through the posterior capsule

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S&S of posterior dislocation

less obvious; often times spontaneously reduce themselves; arm adducted and internally rotated; coracoid process may be more prominent; unwillingness to move the extremity

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Inferior dislocaiton- occurs as a result of

forced abduction with stress applied to the inferior capsule -fairly uncommon and more often it is anterior-inferior

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Chronic Instabilities/ GH dislocation/subluxation: - may have a multidirectional instability- commonly seen in physically active people with inherent instability and weak ___often seen in athletes who perform a lot of __

muscular stabilizing structuresoverhead activities

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Management of GH dislocation

do not reduce-stabilize and refer-evaluate distal pulses and sensations- loss of either constitutes a medical emergency-proper communication with emergency personnel and/or physician

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Bankart Lesion

tear of labrum associated with inferior GH ligament

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Bankart lesion often occus with__

anterior glenohumeral dislocations

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bnakart lesion difficult to identify clinically with the primary complaints being__

paoin and crepitus as the shoulder is evaluated

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s/s of bankart lesion

a sense of instability, repeat dislocations, catching sensations, aching of the shoulder

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Hill-Sachs Lesion

defect in the posterior humeral head’s articular cartilage caused by the impact of the humeral head on the glenoid fossa as the humerus attempts to relocate

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hill-sachs lesion often found with ____

anterior GH dislocations

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Reverse Hill-Sachs Lesion

-same as above, except the lesion is found on the anterior aspect of the humeral head due to a posterior dislocation

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Slap Lesion

superior labrum torn anterior to posterior

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associated nerve injuries are more common than __injuries

vascular

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always need to assess __with injuries

sensation, tingling, numbness, pulses, nail bed refill

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Thoracic Outlet Syndrome:

the thoracic outlet is marked by the anterior scalene muscle anteriorly; the middle scalene posteriorly; and the first rib inferiorly - the brachial plexus and subclavian artery exit through the outlet

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tos s/s

symptoms can very considerably due to location of the compression; pain can occur anywhere between the neck, face, occipital region or into the chest, shoulder and/or upper extremity; complaint of weakness, fatigue or heaviness of the arm and hand

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TOS pain with overhead movements especially ____

abduction and external rotation

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. Impingement-encroachment in the subacromial space that decreases the space through which the ___and ___pass (LH biceps)

supraspinatus and subacromial bursa

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impingement may occur as the result of chromic ____ or in conjunction with acute trauma; individuals may also have chronic glenohumeral instabilities or multidirectional instabilities

inflammation

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3 stages of impingment

1. edema and hemorrhage within the rotator cuff 2. thickening and fibrosis of subacromial bursa and supraspinatus tendon – typically not reversible with conservative treatment 3. degeneration has progressed to a partial or full thickness tear of r.c.

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• Scapular dyskinesis

trapped on thorax and cannot move correctly

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Causes OF impingment

Irregularly shaped acromion, bone spurs• Coracoarcormial ligament Enlarged- inflamed bursa• Thickened rotator cuff tendons, rotator cuff weakness/fatigue• GH instability/laxity• Repetitive overhead movements/overload

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s/s impingment

pain during overhead movement, pain/weakness with rotator cuff/LH biceps, pain at night, shoulder feeling tired, positive impingement special tests

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Created by: jocbutch