Conditions Of The Shoulder Flashcards Preview

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Flashcards in Conditions Of The Shoulder Deck (56)
0

What are the 4 joints of the shoulder?

Sternoclavicular
Acromioclavicular
Glenohumeral
Scapula thoracic

1

GH joint sprain MOI

Arm is forcibly abducted (GH external rotated)
- anterior capsule & GH ligament causing numeral head to 'slip out' of glenoid fossa

2

GH joint sprain S&Sx

Pain in anterior GH
Pain w/ reproduced MOI (abd&ext rot)
Joint laxity
Pain, swelling, & decreased ROM

3

GH joint sprain management

PIER
Immobilization 12-24 hrs
Pain free ROM
Delay external rotation & abduction for 3 weeks, allow capsule to heal

4

Anterior Instability MOI

Blow to post-lateral aspect, forces head of humerus anteriorly in relation to glenoid fossa
Abduction, external rotation & extension

5

Anterior Instability S&Sx

Failure of MGHL, IGHL
Head of humerus lies adjacent to coracoid process
Humerus slides ant. IGHL avulsed from ant. Lip of labrum (Bankart Lesion)

6

Posterior Instability MOI

Occurs when humerus is flexed & int rotated w/ post forces directed along long axis of humerus

7

Inferior Instability MOI

Rare
Primary restraint to motion in superior GH ligament

8

Multidirectional Instability MOI

Damage takes place in more than one plane
Normally ant/post dislocations are associated w/pre-existing inferior laxity or laxity in opposite direction

9

Multidirectional Instability S&Sx

Pain/clicking w/ simple tasks
Need to identify multidirectional instability to address all areas of weakness

10

Multidirectional Instability Management

Conservative
Surgery for those who do not respond to conservative Rx

11

Sternoclavicular Joint Sprain MOI

Compression related to a direct blow
-individual side lying & player falls on top
Indirect force due to FOOSH
- anterior displacement

12

Sternoclavicular Joint Sprain S&Sx

G1: TOP w/no visible deformity
G2: joint subluxation (bruising, swelling & pain/ pain w/ cross-flexion, joint compression
G3: prominent displacement, may involve #, unable to perform scapular protraction, numbness, tingling due to compression of thoracic inlet

13

Sternoclavicular Joint Sprain Management

G1: PIER, sling (1-2 weeks)
G2: longer immobilization (3-6 weeks) - sling/ figure 8 brace
G3: immediate reduction by MD, immobilization,

14

AC joint Sprain MOI

Fall on tip of acromion, fall transmitted along axis of humerus w/lumbar adduction

15

AC joint sprain Sx

G1: no disruption of AC/CCL min swelling, pain past 90* abduction
G2: AC ligament, CCL rupture, clavicle rides above level of acromion, minor step/gap at joint line, pain increases
G3: rupture of AC joint ligament, CCL & tearing of deltoid fascia, may involve neurological Sx

16

AC Joint Sprain Management

G1&2: PIER, sling (1-3 weeks), RTP: Pad/tape to prevent further injury, Approximate ends of injury w/ pressure & compression
G2+: May be managed both operatively & non
G3: Surgery w/immobilization 4-6 weeks, strengthening (pre-surgery)

17

Acute Dislocations MOI

May be associated w/# or nerve damage, may require EAP to be activated

18

Acute Dislocations S&Sx

Intense pain,
Tingling/numbness
Prominent acromion, humeral head palpated in axilla
Arm held at 20-30* abduct (ant disloc)
Arm held in full adduct (post disloc)
Ant delt is flat (post disloc)

19

Acute Dislocations Management

1st time disloc = immediate referral
Treat as a # & splint in position of comfort
PIER unless neurological components affected

20

What is Hill Sachs Leision

Small defect found in humeral head after ant disloc
Caused by impact of humeral head on glenoid fossa
Rarely symptomatic may lead to degeneration of joint

21

How do you test for an Acute dislocation?

Apprehension test
Posterior apprehension
Sulcus Sign

22

Chronic Dislocations MOI

Ant disloc, intracapsular
Same MOI as acute
As # increase force needed to produce injury decrease

23

Chronic Dislocations S&Sx

Pain, crepitation, clicking as arm shifts back to appropriate position,
Individual voluntary decreases disloc

24

Chronic Dislocations Management

If injury does not reduce, sling & swathe, PIER & refer
Restore normal motion w/ strengthening
Surgery may be warranted if instability persists

25

Glenoid Labrum Tears MOI

Tearing of labrum & IGHL (Bankart)
Associated with trauma & ant instability
Injury to superior labrum
Disrupts LH biceps (SLAP) lesion

26

Glenoid Labrum Tears S&Sx

Pain, weakness when arm is over head (abd& external rotation)
Results of disloc/subluxation

27

Glenoid Labrum Tears Management

Conservative Rx, rest, NSAIDs
Surgery may be warranted if individual doesnt respond

28

How does bursitis of the shoulder occur

Works w/ impingement syndrome
Usually subacromial bursa-impinged w/ over head activities

29

Bursitis S&Sx

Sudden shoulder pain w/ initiation, acceleration of throwing motion
Pt. tenderness ant & lateral edges of acromion
Painful arc
Pain referred to distal deltoid attachment

30

Bursitis Management

Acute care protocol
R/O other conditions
Find cause,treat cause

31

What Special test can you perform to test for Bursitis of the shoulder?

Hawkins Kennedy (supraspinatus/biceps)
Drop Arm (supraspinatus)
empty Can (supraspinatus)

32

Bicipital Tendonopathy MOI

Repetitive overuse during rapid motion involving elbow flexion & supination
Irritation occurs as tendon moves in Bicipital groove

33

Bicipital Tendonopathy S&Sx

TOP Bicipital groove
+ve yergasons & speeds test

34

Bicipital Tendonopathy Management

Restriction of rotational activities
Due to potential vascular impingement when arm is fully addicted, slightly abducted in sling if immobilized
PIER, modalities

35

Traumatic Clavicular # MOI

Frequently occur in middle 1/3 of clavicle (where it changes direction)

36

Traumatic Clavicular # S&Sx

Swelling, ecchymosis deformity
Pain w/GH movement

37

Traumatic Clavicular # Management

Immobilization in cling & swathe
Following Ax by GP, figure 8 brace

38

Scapular # MOI

Avulsion # of coracoid
Direct contact

39

Scapular # S&Sx

Minimal displacement, localized hemorrhage
Individual reluctant to abduct GH
Pain
R/O underlying pulmonary injury

40

Scapular # Management

Immobilize in sling & swathe
Refer to MD

41

Epiphyseal & Avulsion # MOI

Epiphyseal centres at shoulder remain unfused longer period of time
Prox humeral epiphysis close at 18-21
Little league shoulder to repetitive med. rot. & adduction
Avulsion to coracoid process w/young adults w/repetitive forceful throwing

42

Epiphyseal & Avulsion # S&Sx

Acute shoulder pain when attempting to throw hard
Pain w/deep palpating in axilla
Avulsion #, pain w/palpating at site

43

Epiphyseal & Avulsion # Management

Immobilize in sling & swathe
PIER

44

Torticollis MOI

Scoliosis of c-spine, SCM
Deformity in which head tilts toward one shoulder & chin rotates toward opposite shoulder
"Wry neck" result of muscular strain following exposure to cold/sleeping w/neck in abnormal position

45

Torticollis S&Sx

Abnormal neck position

46

Torticollis Management

Usually resolves spontaneously in 2 weeks
Modalities & ROM

47

C-spine Sprain MOI

Extreme motion or violent muscle contraction
Maintaining head in one position, may also produce sprain

48

C-spine Sprain S&Sx

Pain
Stiffness
No neuro

49

C-spine Sprain Management

Modalities
Limiting ROM

50

C-spine Strain MOI

Usually involves SCM/upper traps
May also involve scalenes, levator scap
Same MOI as sprain

51

C-spine Strain S&Sx

Pain
Stiffness
Restricted ROM
Muscle spasm

52

C-spine Strain Management

Modalities
C-collar
Strengthening

53

Throacic Outlet Compression Syndrome Etiology

Nerves &/or vessels become compressed in proximal neck/axilla I. 2 forms:
1) Neurological - stretch or compression of nerve
2) Vascular - Impingement of subclavian artery/vein

54

Throacic Outlet Compression Syndrome S&Sx

Nerve- aching pain, pins & needles/numbness, weakness
Vascular - blockage of subclavian vein (Edema/stiff hand)
- occlusion of artery (rapid onset, coldness/numbness arm, fatigue)

55

Throacic Outlet Compression Syndrome Management

Conservative Rx - Ax muscle strengthening & posture