the shoulder anatomy separations fractured clavicle dislocations supraspinatus tendonitis
TRANSCRIPT
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THE SHOULDER
Anatomy
Separations
Fractured Clavicle
Dislocations
Supraspinatus Tendonitis
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THE SHOULDER
Scapulothoracic
Acromioclavicular
Sternoclavicular
Glenohumeral
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Shoulder (Anterior View)
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Acromioclavicular Separation
Mechanisms of Injury:
Fall on the tip of the unprotected shoulder.
Fall on the outstretched hand.
Downward force on the acromion from above.
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Grade of Injury of A/C
Grade 1:
Small tear of the capsule of the AC joint. No instability of joint.
P.O.P.
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Grade 2: Tear of the A/C joint capsule and a small tear of the coraco-clavicular ligaments.
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Degree of Injury of A/C
Grade 3: Tear of the acromio-clavicular ligament and the coraco-clavicular ligament.
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Distal End of Clavicle
GRADE 3 A-C
SEPARATION
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INSTABILITY OF A-C Jt.
Grade 1: No instability of acromio-clavicular joint.
Grade 2: Slight instability of A-C joint. ‘Springy’ clavicle.Grade 3: Total separation of A-C joint. The clavicle goes superiorly.
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ACTIVE MOVEMENTS TO ASSESS A-C Jt.
Abduction
Cross Flexion
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CROSS FLEXION
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Active Abduction of the Shoulder Joint
Grade 1: Full R.O.M. with pain at end of range.
Grade 2: Has over 45º of motion but not 90º.
Grade 3: less than 45º.
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Return Time Estimates
Grade 1: One week to ten days.
Grade 2: Two to three weeks.
Grade 3: Four to six weeks.
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CRITERIA FOR RETURN
Medical clearance.
Full Range of Motion.
Strength with 90%
Able to do “high five”
Protect the joint.
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CLAVICLE
• ‘S’ shape bone.
• Protects neuro-vascular bundle and for muscle attachment.
• Securely anchored at either end.
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CLAVICLE FRACTURE
Any force that brings the shoulder to the midline of the body.
Direct impact to clavicle from superior or anterior direction.
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Clavicle Fracture: Signs & Symptoms
Pain and loss of function of shoulder.
Spasm of trapezius and SCM (sternocliedomastoid) m.
Arm held to body, shoulder elevated.
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Clavicle Fracture: Signs & Symptoms
May be palpable deformity when palpating the clavicle.
In a pre-pubescent person, they may get a ‘greenstick’ fracture.
MEDICAL REFERRAL!
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Clavicle
1st RibSternum
Sternocavicular Ligament
Costoclavicular Ligament
Sternoclavicular Joint
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STERNOCLAVICULAR JOINT SEPARATION
Very stable joint. Major ligaments are the sternoclavicular and costo-clavicular ligaments.
Mechanism of Injury is the same as for the A.C. joint.
Pain. Loss of motion. The unaffected side looks higher.
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PENDULAR EXERCISES
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Flexion
Adduction Abduction
Extension
CW RotationCCW Rotation
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ANATOMICAL PREDISPOSITION TO
DISLOCATION
• Glenoid Defects
• Labral Defects
• Neuromuscular Disorders
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LUX = DISLOCATE
SUBLUX = PARTIAL DISLOCATION
TERMINOLOGY
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TRAUMATIC
Single force applies excessive overload to the soft tissues of the joint and often damages the Glenoid Labrum (Bankart Lesion) and the joint capsule.
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ATRAUMATICAthlete who has multiple joint laxities, who had frequent episodes of sub-luxations before and a relatively minor one results in dislocation. (Congenital hypermobility and/or muscle weakness)
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ACQUIRED
Sports such as swimming, gymnastics and baseball where repetitive micro-trauma, poor stretching and motion lead to capsular stretching. Eventual feeling of instability.
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Bones of Shoulder Joint
Acromion Process
Clavicle
Posterior Anterior
Glenoid
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LABRUMCartilage ring around the glenoid. Deepens the socket of the G-H Joint.
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Superior, Middle and Inferior Glenohumeral Ligament
Coracoclavicular Acromioclavicular
Coraco-acromial Lig.
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Pectoralis Major
Long Head of Biceps
Deltoid
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1 23
4
1. Subscapularis
2. Supraspinatus
3. Infraspinatus
4. Teres Minor
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Supraspinatus
Infraspinatus
Teres Minor
Posterior Musculature
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PRIMARY MOVERS
DeltoidPectoralis Major
(Latissimus Dorsi is posterior)
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TYPES OF DISLOCATIONS
Anterior (85%)
Inferior (5%)
Posterior (10%)
Subcoracoid Dislocation
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ANTERIOR DISLOCATION
Arm in abduction and external rotation. Force is taken on the hand or arm which increases the external rotation of the arm causing the head of the humerus to dislocate.
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INFERIOR DISLOCATION
Arm is in excessive abduction and a force is taken on the hand pushing the head of the humerus inferiorly out of the glenoid.
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Subcoracoid Dislocation
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Subcoracoid Dislocation
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Anterior Dislocation
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Subcoracoid Dislocation
The elbow is held away from the side and the hand can not turn onto the stomach.
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POSTERIOR DISLOCATION
The arm is in flexion and adduction. Force is taken on the hand, causing the head of the humerus to be push out the glenoid posteriorly.
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POSTERIOR DISLOCATION
The coracoid process may be prominent. The elbow will be at the side and the hand on the stomach. Attempting to turn the arm out causes shoulder pain.
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For any dislocated shoulder, do not try to reduce the joint. Do not pull on the arm.
Try to immobilize as best you can (difficult).
Medical referral!
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Recurrent dislocations have nothing to do with the treatment after the first dislocation.
Recurrent dislocations are dependent upon the damage that happens during the first dislocation.
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APPREHENSIVE SHOULDER TEST
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When an athlete subluxes the glenohumeral joint, they experience a Dead Arm.
We do an Apprehension Test for the shoulder to determine if they subluxed the shoulder.
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Apprehension Test
• Tell you to stop
• Roll their body towards the arm.
• Fight what you are doing
• Pull the arm to the body
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OVERUSE INJURIES OF THE SHOULDER
SUPRASPINATUS IMPINGEMENT
OF THE SHOULDER
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IMPINGEMENT
To impinge is to pinch.
The supraspinatus gets pinched between the humerus and the acromion and/or the coracoacromial ligament.
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SUPRASPINATUS MUSCLE
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FLEXION IMPINGEMENT
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SIGNS AND SYMPTOMS
• Painful Arc (Abduction)
• Hand Behind Back decreased.
• Weakness of external rotators of the
shoulder.
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INITIAL TREATMENT
• Stretch into internal rotation.
• Strengthen external rotators.
• Modify activity.
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Hand Behind Back
• One arm at a time.
• Thumb to middle of back.
• Move up back.
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STRETCH INTERNAL ROTATION
Arm with limited internal rotation.
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EXTERNAL ROTATION STRENGTHENING
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MEDICAL REFERRAL
PHYSIOTHERAPY