Injuries of the Shoulder Mechanism, Evaluation and Treatment.
-
Upload
jemimah-thomas -
Category
Documents
-
view
224 -
download
0
Transcript of Injuries of the Shoulder Mechanism, Evaluation and Treatment.
Injuries of the Shoulder
Mechanism, Evaluation and Treatment
Rotator Cuff StrainMechanism
Typically from a violent pull of arm, an abnormal rotation force, or a fall on outstretched arm (foosh).
Sometimes from repetitive motion (throwing, tennis, swimming)
Rotator Cuff StrainSigns & Symptoms
Loss of functionPain and tendernessLack of normal shoulder flexibility and strength
Special TestsDrop Arm Test – Supraspinatus – abduct as far as
possible then return to 90 and try to hold – if drop then torn
Empty Can Test – checks supraspinatus – check strength in empty can motion at approx 45 degrees
Apley’s Scratch Test – checks all muscle motions
Drop Arm Test
Empty Can Test
Rotator Cuff StrainManagement
Rest if necessary and IceRehabilitation emphasizing stretching &
strengtheningSurgery on a rare occasion
Acromioclavicular Sprain or Separated Shoulder
MechanismDirect blow to tip of shoulder or foosh driving arm
against the acromionDamages the ligaments and acromion and clavicle
may separate.May be classified as first, second, or third degree
sprains.
Acromioclavicular Sprain or Separated Shoulder
Signs and SymptomsPain and tenderness at end of the collar boneDeformity caused by upward displacement of
collar boneLoss of function
Special TestsDistraction (Piano Key)
Acromioclavicular Sprain or Separated Shoulder
Management Ice to control bleeding and swelling Immobilization with sling and swatheRehab to restore normal strength & flexibilityProtective taping and paddingOut how long???? Depends on degree of
separation and amount of pain can tolerate
Anterior DislocationMechanism –
when arm is forcefully abducted and externally rotated (ex. Abnormal force to an arm that is executing a throw or and arm tackle)
A fall on an armHumeral head slips forward out of the glenoid
fossa.Often causes a labral tear.
Anterior DislocationSigns and Symptoms
Pain and TendernessDeformity – flattened shoulder contour – stair
step defectLoss of function – arm will just hang
Special TestsApprehension – abduct arm to 90 degrees
then force arm into external rotation Relocation test – do apprehension test but
hold glenohumeral head in place
Shoulder Dislocation
Apprehension Test
Relocation Test
Anterior DislocationManagement
Cold Application Immobilization
AS IS – DO NOT RELOCATE ON OWN.Rehabilization
Restore normal strength and flexibilityBrace
Sully Brace – Limit ROM – esp. Abduction/External Rotation
Surgery
Glenoid Labrum Tear (Labral Tear)
MechanismAnterior Dislocation/Subluxation of glenohumeral
jointRepetitive shoulder motionAcute trauma
Glenoid Labrum Tear (Labral Tear)
Signs & SymptomsPain changes smooth motion of shoulderFeels or hears pop with forced external rotationPain with external rotation at 90 degrees of
abduction – apprehension testWeakness of rotator cuffPossible positive clunk testPain with forced horizontal adduction
Clunk Test
Long Thoracic Nerve Contusion
Mechanism Indirect trauma to shoulder or thoracic wall, overuse
or prolonged traction (as in cycling)
Signs & SymptomsPain, dull ache in shoulderProtruding/winging scapula due to weak serratus
anterior muscle due to damage to nerve
Long Thoracic Nerve Contusion
Special TestWall push up
Clavicle FractureBroken Collar Bone
MechanismFooshfall or hit on tip of shoulder
Signs & SymptomsHolding up armHead toward injured sidePossible deformity & crepitus
Clavicle FractureTreatment
X-raySurgery
Bicep TendinitisMechanism
Irritation of the Bicep Tendon
Signs & SymptomsPain, feel like bicep is moving
Special TestsSpeed’s Test – resist shoulder flexionYergason Test – athlete tries to keep arm from
externally rotating and extending the elbow – checks for bicep stability
Bicep RuptureMechanism
Violent contraction
Signs and symptomsHears/feels a sensation of rolling up of the armProtruding bulge in the bicep – divet in armLoss of function/strength
TreatmentRefer to orthopedic surgeon
Bicep Rupture
Rotator Cuff ImpingementMechanism
Caused due to swelling in AC joint. No where for swelling to go. Rotator cuff is impinged in the joint.
Special Tests Impingement Tests
Force arm into horizontal adductionEmpty Can Test
Resisted as empty can motion at 45 degree angle
Rotator Cuff Impingement
Impingement Test
Other Typical InjuriesBursitis
Contusion
Fracture
Prevention of Shoulder Injuries
Overall Conditioning
Strengthen in Full ROM
Warm Up properly before explosive arm movements
Instruct in proper falling techniques
Protective equipment
Teach proper mechanics
Avoid overuse
Sport Specific Training
VideosShoulder Injuries (9:58)http://www.bing.com/videos/watch/video/shoulder-injuries/a31bc6c1eb13284489f0a31bc6c1eb13284489f0-289506132305?q=shoulder%20injury%20videosShoulder Injuries (Part 1) (15:03)http://www.youtube.com/watch?v=yVoFmYJLx74Shoulder Injuries (Part 2) (11:38)http://www.youtube.com/watch?v=Q4fFV07ITNE&feature=channelShoulder Dislocation (X-ray) (1:00)http://www.youtube.com/watch?v=8_tQJDR7ORc&feature=related
VideosUnderstanding Shoulder Pain (Sports Injuries #3)
(2:59) http://www.youtube.com/watch?
v=HULJU_ROdCI&feature=rec-LGOUT-exp_fresh+div-HM
Shoulder Dislocation Dwyane Wade (3:00)http://www.bing.com/videos/watch/video/dwyane-
wade-shoulder-injury/27b33922cf2f85a7e6cf27b33922cf2f85a7e6cf-302259110559?q=shoulder%20injury%20videos
Shoulder Injury Campbell (Raiders) (1:13)http://www.nfl.com/videos/nfl-game-highlights/
09000d5d81a17e3b/Campbell-injuryShoulder dislocation wrestling (0:19)
http://www.youtube.com/watch?v=-Hv8FM78I7I