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22 Cards in this Set
- Front
- Back
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Shoulder intro |
- Shoulder is 3 joints and a pseudo joint Shoulder girdle is a scapula, clavicle and manubrium - Structural stability compromised for mobility Primary function is positioning the hand Shoulder pain is third most common consulted complaint - intrinsic or referred. Susceptible to overuse injuries. |
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Bony anatomy |
Scapula (with processes) Clavicle Humerus (with tuberocities and sulcus) |
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Joint anatomy |
Glenohumeral ("shoulder") Acromioclavicular (AC joint is separation) Sternoclavicular (SC joint connects all shoulder to body) Scapulothoracic |
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Anatomy - ligaments |
Sternoclavicular - Costoclavicular Acromioclavicular - Coracoacromial Glenohumeral - Rotator cuff tendons - Long head of biceps tendon - Transverse ligaments - Long head of triceps tendon |
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Anatomy - muscles |
Deltoid, pecs, triceps, biceps, RC, Levator scapulae, serratus anterior, serratus posterior. |
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Anatomy - Bursae |
Subacromial bursa - in subacromial space - Cushions RC muscles from acromion - COmpressed during overhead arm action. Subcoracoid; Subscapularis |
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Anatomy - Neurovascular |
- Axillary artery - Posterior scapular nerve - Medial cord |
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Functional Anatomy |
Scapulohumeral Rhythm - mvmt of scap relative to hum - Inguinal 30 deg of abduction setting phase -2:1 ratio of shoulder rotation to scapular rotation. - 180 deg total ROM 120 GH, 60 scapulothoracic |
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SHoulder injury prevention |
Protective equipment - shoulder pads Physical conditioning - warm up, flexibility, strength Prper skill technique - mechanics, falling technique. |
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Common shoulder injuries |
Acute: Contusions (delt), Sprains (SC, AC, GH), strains (delt, biceps, triceps), ruptures (biceps), fractures (clavicular, humeral), GH dislocations/ subluxations Chronic: RC impingement syndrome, bivipital tendonitis, sub acromial bursitis. |
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FOOSH |
Fall On an Outstretched Hand |
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Clavicular fracture |
E: FOOSH, fall on tip of shoulder, direct impact, mid third (typically greenstick). S&S Supporting the arm, head tilted towards injury, chin tucked away, clavicle may be lower, palpation = pain, swelling, deformity, pt tenderness. M: Shock, sling, hospital. 6-8wk brace. Ensure pulse in distal limb. |
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HUmeral Fracture
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E: Direct blow, FOOSH. Fracture in shaft, at head, supracondylar, epiphyseal. Check for dislocation if proximal #. S&S: Pain, swelling, pt tenderness, decreased ROM, may mistake for contusion! M: Treat for shock, splint, sling, hospital. |
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SPlains - Acromioclavicular |
E: Direct blow, fall on pt of shoulder, FOOSH. Grades 1-6 S&S: Mild to severe pain, swelling, altered ROM (ABduction and ADduction), step deformity. M: Ice, stabilization, referral. Grades 1-3 non operative, 3-4 days and 2 weeks imobilization. Grades 4-6 require surgery Aggressive rehab for all grades. |
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Grades on the acromioclavicular sprains |
Grade 1: No disruption Grade 2: Tear of the AC ligament, partial displacement. Grade 3: Rupture of the AC and CC ligaments Grade 4: Posterior separation of lateral clavicle Grade 5: Complete ligamentous ruptiure, tearing delt and trap attachments. Grade 6: Inferoposterior displacement |
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Sprais - sternoclavicular |
E: Indirect force, blunt trauma. S&S: Grade 1 - pain/ slight disability Grade 2: pain, subluxation, deformity, swelling, pt tenderness, decreased ROM Grade 3: gross deformity (dislocation), pain, swelling, decreased ROM M: RICE< reduction if necessary, Immobilize 3-5 wks note: if clavicle goes back can hurt the trachea. |
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Sprains Glenohumeral |
E: FOrced abduction and or ext rotation or direct blow. S&S: Pain during movement esp in MOI Decreased ROM and pain w/ palpitation M: RICE for 24-48 hrs Regaining ROM then strength (therapy) Note: be aware of development of chronic conditions |
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Acute subluxations and silocations |
E: Anterior dislocation - anterior force forced abduction and external rotation. Posterior dislocation - forced adduction and internal rotation, falling on extended hands and Internal rotation of GH. S&S: Anterioinferior - flattened delt, head in axilla, arm carried in a slight abduction and external rotation. Moderate pain and disability. Posterior - severe pain and disability, arm carried in adduction and IR. Acromion and coracoid prominent, limited ER and elevation. M: RICE and reduction by physiccian. Imobilize, sling, swathe, isometrics while in sling. |
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Tissues damaged with GH dislocation |
Capsule, ligaments, tendons, labrum = the cartilage socket (SLAP lesion = superior labral tear from anterior to posterior) Brachial nerves and vessels Fractures (bone) Hill Sachs lesion - caused by compression of cancellous bone against anterior glenoid rim creating a divot in humeral head. |
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Shoulder Impingement - Subacromial bursitis |
E: Bursal inflammation compressing tendons Contributing factors: joint laxity, postural malalignments, repetitive overhead motions. S&S: Diffuse pain, palitation pain, increase GH ER and decreased IR, positive painful arc and impingement tests. M: Active rest, ice, correct biomechanics, NSAIDS |
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Bicipital tenosynovitis |
E: Repetitive overhead ballistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath; improper mechanics; impingement. S&S: Tenderness over bicipital groove, swelling, crepitus due to inflammation. Pain when performing overhead activities. M: Rest, ice and therapy to treat inflammation. NSAIDS, gradual program of strengthening and stretching. Inflammation of bundling around tendons. |
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Biceps brachii rupture |
E: Result of powerful contraction typically near muscle origin S&S: Patient hears resounding snap, sudden intense pain, deformity, weakness w/ elbow flex and supination. M: Ice for hemorrhaging, sling, refer. Surgery required. note: tenosynovitis = predisposition. Bottom will be re-attached. |
