Download Recognition of Shoulder Injuries

Recognition of Shoulder Injuries
Treatment & Evaluation
Standard 17
I WILL…describe the principles of common shoulder injuries,
mechanism of injury, special test, and rehabilitation progression.
The mission of the Cane Ridge Academy of Health
Management is to provide a solid academic foundation in a
nurturing environment that prepares students with the
professional skills necessary for post-secondary academics
and healthcare related careers.
Boney Anatomy
• Humerus
–
–
–
–
Humeral head
Greater Tubercle
Lesser Tubercle
Bicipital groove
• Scapula
–
–
–
–
Acromion
Coracoid Process
Scapular Spine
Inferior Angle
Shoulder Stability/Instability
Glenoid Labrum & 4 Rotator Cuff
Muscles give shoulder joint it’s stability
Boney Anatomy
• Glenohumeral Joint
– Ball and Socket
– Head articulates with
glenoid cavity
– Cavity deepened by
Glenoid Labrum
– Maintained by labrum,
ligaments, deltoid and RTC
Boney Anatomy
• Acromioclavicular Joint
– Gliding articulation
– Lateral end of clavicle with
acromion process
– Weak Junction
– Disc separates the two
articulating surfaces
Boney Anatomy
• Sternoclavicular Joint
– Clavicle articulates with the
manubrium of sternum
– Only direct connection
between UE and Trunk
• Scapulothoracic Joint
– Not a true joint,
articulation
– Movement of Scapula on
wall of thoracic cage is
critical
Soft Tissue Anatomy
• Ligaments
– Attach bone to bone
• Sternoclavicular joint ligaments
– Anterior: prevents upward
displacement of clavicle
– Posterior: prevents upward
displacement of clavicle
– Lateral: prevents lateral
displacement of clavicle
Soft Tissue Anatomy
• Ligaments
– Attach bone to bone
• Acromioclavicular joint ligament
– Anterior, posterior, superior
and inferior
– Coracoclavicular joint ligament
• Glenohumeral joint ligaments
– Superior, middle and inferior
– Coracohumeral ligament
Soft Tissue Anatomy
• Muscles*
– Rotator Cuff RTC
•
•
•
•
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
– IR, ER and ABD
–
–
–
–
–
–
Biceps Brachii
Deltoid
Pectoralis major
Teres major
Triceps Brachii
Latissimus dorsi
Anterior Anatomy
Posterior Anatomy
Soft Tissue Anatomy
• Glenoid Labrum
– Cartilage
Muscle Grade Strains
Grade 1
• Over stretched
• Micro tears possible
• Mild pain
• With or without
swelling
• RICE
• Rehab
Grade 2
• Over stretched
• More tears, but not
complete
• Pain
• Swelling
• Point tender
• Possible Ecchymosis
• Possible decreased ROM
• RICE
• Refer
• Rehab
Grade 3
• Most of the fibers torn
if not complete rupture
• Pain
• Swelling
• Point tender
• Ecchymosis
• Decreased ROM
• Refer
• Surgery in most cases
• Rehab
RTC Strain
MOI:
• Usually a sudden powerful
movement
– Falling on outstretched
hand
– A sudden thrust
– Following a pitch
• Lifting
• Pulling
• Repetitive stress
Signs & Symptoms
• See previous slide
RTC Tendonitis
MOI
• Caused by overuse
– Swim and throwing common
• Overload-walking a dog, dog
keeps pulling
Signs & Symptoms
• Pain can be present during
activity and rest
• Pain can radiate down
• Pain with lifting and
reaching movements
• May lose strength and
motion
• ADLs may become difficult
Acromioclavicular Sprain
MOI
Signs & Symptoms
• Direct impact
• Upward force
•
•
•
•
•
•
•
6 grades
Point tender
Deformity possible
Possible ROM deformity
Instability of shoulder
Possible ecchymosis
Possible swelling
Acromioclavicular Sprain
Sternoclavicular Sprain
Concern – Breathing & Blood Flow compromise
Fractured Clavicle
Impingement
MOI
Signs & Symptoms
• Compression of supraspinatus
tendon, subacromial bursa and
long head of biceps tendon
• Overhead activities
– Throwing
– Swimming
– Tennis serve
– Spiking
• Diffuse pain around acromion
• Point tender over supraspinatus
or biceps tendon
• Overhead Increases pain
• Achy when done workout
• ER weaker than IR
Glenoid Labrum Tear
MOI
Signs & Symptoms
•
•
•
•
•
•
•
•
•
•
•
Falling on outstretched arm
Direct blow to shoulder
Sudden pull (lift heavy object)
Throwing or weightlifters can tear
it with repetitive shoulder motion
Pain
Catching, clicking and/or popping
Night pain – trouble sleeping
Pain with activity
Instability
Decrease strength
Decrease ROM
Biceps Tendonitis
MOI
• Repetitive overuse of biceps
tendon
• Throw, swim or swing
• Can be acute - fall
Signs & Symptoms
• Pain over biceps tendon
• Pain with overhead activity
• May feel weak
Frozen Shoulder
MOI – shoulder pain that causes the patient to stop utilizing
his/her shoulder due to pain.
• Decrease in shoulder ROM
• Prominent in older females
• Can not perform overhead activates
• Treatment - PT
Winging scapula
MOI – damage to the long thoracic nerve that innervates
the serratus anterior muscle (SAM pulls scapula forward)
Prophylactic Bracing
ROM Exercises
Towel Slides- flexion/extension
Codman’s- circular motion- clock & counter clock
Wall finger climb - flexion
Pulley – active/passive
Wand assist – prone flexion
Strengthening
Isometric contraction
Theraband-flexion,extension, abduction, IR, ER, SS
Dumbbell
Manual
Proprioceptive
Unstable surface
Positional changes
Shoulder Injury Exit Ticket
1.
2.
3.
4.
5.
6.
What is the purpose of the glenoid labrum?
List the 4 joints of the shoulder complex
List the four muscles of the RTC
MOI of Impingement?
Define Frozen Shoulder and it’s MOI?
What 2 structures give the shoulder stability?
Shoulder Do Now…
1.
2.
3.
4.
5.
6.
7.
Frozen shoulder effects what demographic the most often?
List 2 ROM exercises.
List the 5 RTC strengthening movements?
Define a winging scapula
Common complaint for a glenoid labrum tear?
List the three bones the glenoid joint.
MOI for AC sprain