The Shoulder Unit 16 Upper Extremity Injuries - PowerPoint Presentation

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The ShoulderUnit 16

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Upper Extremity Injuries

Upper extremities are vulnerable to a variety of injuries depending on the sport, including:

Sprains

Strains

Dislocations

Fractures

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Upper Extremity Injuries

Upper extremities are vulnerable to a variety of injuries depending on the sport, including:

Separations to the thoracic cage, shoulder, arm, and hand

Repetitive motion injuries such as arthritis, bursitis, tendonitis

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Shoulder Complex Physiology

Bones

Muscles

Tendons

Ligaments

Articulations

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Bones

Humerus

Scapula

Clavicle

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THE JOINTS

Sternoclavicular joint (SC joint)

Sternoclavicular ligament

Coracoclavicular joint

Coracoclavicular ligament

Acromioclavicular joint (AC joint)

Acromioclavicular ligament

Coracoacromial joint

Coracoacromial ligament

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Glenohumeral joint

Glenohumeral ligaments

Scapulothoracic articulation

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Muscles in motion

FLEXION

Anterior deltoid

Primary mover

Biceps brachii

Secondary mover

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EXTENSION

Posterior deltoid

Prim. Mover

Triceps brachii

Sec. Mover

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ABDUCTION

Supraspinatus

1st 5-10 degrees

Middle deltoid

Last 90 degrees

Trapezius

Assists in movement above 90 degrees

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ADDUCTION

Latissimus dorsi

Pectoralis major

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HORIZONTAL FLEXION

Pectoralis major

Anterior deltoid

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HORIZONTAL EXTENSION

Posterior deltoid

Infraspinatus

Teres minor/major

Rhomboids

Trapezius

Stabilizer

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CIRCUMDUCTION

Basically all muscles of the shoulder

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INTERNAL ROTATION

Subscapularis

Pectoralis major

Little help

EXTERNAL ROTATION

Infraspinatus

Teres minor/major

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Scapular Elevation

Scapular Depression

Scapular protraction

Scapular retraction

****find muscles that perform these motions

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Assessing Shoulder Injuries

H

O

P

S

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History

What is the cause of pain?

Mechanism of injury?

Previous history?

Location, duration and intensity of pain?

Creptitus

, numbness, distortion in temperature

Weakness or fatigue?

What provides relief?

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ObservationElevation or depression of shoulder tips

Position and shape of clavicle

Acromion process

Biceps and deltoid symmetry

Postural assessment (kyphosis, lordosis, shoulders)

Position of head and arms

Scapular elevation and symmetry

Scapular protraction or winging

Muscle symmetry

Scapulohumeral

rhythm

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Palpation

Bony structure palpation should occur bilaterally and simultaneously if possible

Palpate soft tissue structures for point tenderness, swelling, spasms, lumps, guarding or trigger points

Be sure to palpate anteriorly and posteriorly

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Special Tests

ROM test for external rotation of the shoulder

ROM test for internal rotation of the

shoulder

Specific ROM tests for the shoulder

including abduction, adduction, flexion, extension,

horizontal adduction, horizontal abduction

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Manual muscle tests for the shoulder

External rotation strength tests

Internal rotation strength test for the shoulder

Extension strength test for the shoulder

Flexion strength test for the shoulder

Abduction and adduction strength tests for the shoulder

Empty can test

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Apprehension test (Crank test)

Apprehension test used for anterior glenohumeral instability

This motion should not be forced

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Test for Shoulder Impingement

Neer’s test and Hawkins-Kennedy test for impingement used to assess impingement of soft tissue structures

Positive test is indicated by pain and grimace

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Test for Supraspinatus Weakness

Empty Can Test

90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction

Downward pressure is applied

Weakness and pain are assessed bilaterally

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Types of Shoulder Injuries

Fractures

Clavicle, humerus, scapula

Cause: fall on outstretched arm, direct blow

S/S: pain, deformity, decreased ROM, swelling

Perform percussion test, compression test

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Treatment

Sling/splint

PRICE

Physcian/EMS

Follow orders

Prevention:

Instruct how to fall

Proper equipment

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Hockey Clavicle Fracture

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Dislocations and subluxations

AC, SC, GH jts

Cause: head of humerus forced/displaced from glenoid

S/S: pop, dead arm, pain, deformity, swelling, loss of ROM/strength

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Treatment

DO NOT relocated

PRICE

Check circulation/sensation

Physician / x-rays

Follow orders

Prevention

Strengthen jt

Proper equipment

Falling

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Anterior Posterior

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Posterior

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Shoulder

dislocation

-rugby

Dwayne Wade

http://www.youtube.com/watch?v=09ZZbJzeKUA

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Contusions

Cause: direct blow/bony area or muscles

S/S: pain, decreased ROM, r/o other injuries

Treatment: ice, padding, rehab, flexibility

Prevention: proper equipment, mechanics

Myositis

ossificans

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Sprains

Cause: over stretch/tear ligament, capsule

What motions/events would cause this?

S/S: pt tender, weak, swelling, instability, possible deformity, decreased ROM

Treatment

PRICE

Physician, follow orders

Rehab

Prevention

Proper equipment/technique

Strengthening/stretching

Inspect playing areas

Taping/bracing

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Sternoclavicular Sprain

Cause of Injury

Indirect force, blunt trauma (may cause displacement)

Signs of Injury

Grade 1 - pain and slight disability

Grade 2 - pain, subluxation w/ deformity, swelling and point tenderness and decreased ROM

Grade 3 - gross deformity (dislocation), pain, swelling, decreased ROM

Possibly life-threatening if dislocates posteriorly

Care

PRICE, immobilization

Immobilize for 3-5 weeks followed by graded reconditioning

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Acromioclavicular Sprain

Cause of Injury

Result of direct blow (from any direction), upward force from

humerus

, fall on outstretched arm

Signs of Injury

Grade 1

- point tenderness and pain w/ movement; no disruption of AC joint

Grade 2

- tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM (abduction/adduction)

Grade 3

- Rupture of AC and CC ligaments with dislocation of clavicle; gross deformity, pain, loss of function and instability

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Care

Ice, stabilization, referral to physician

Grades 1-3 (non-operative) will require 3-4 days (grade 1) and 2 weeks of immobilization ( grade 3) respectively

Aggressive rehab is required w/ all grades

Joint mobilizations, flexibility exercises, & strengthening should occur immediately

Progress as athlete is able to tolerate w/out pain and swelling

Padding and protection may be required until pain-free ROM returns

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Specific tests

Sulcus test, apprehension test for sprain of the anterior capsule

Acromioclavicular (AC) sprain test

Sternoclavicular (SC) sprain test

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Types of Shoulder Injuries

Strains

Cause: overstretching of muscles

S/S: similar to sprains

Treatment: PRICE, physician if necessary, follow orders, rehab

Prevention

Stretching, strengthening

Drop arm test-specific test

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What do you see?

L clavicle elevation, bruising, left shoulder higher

What do you think the injury is?

Grade 2 AC sprain, left. Bull rider

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Impingement

Cause: pinching of soft tissue w/overhead activity; overuse

S/S: pain, weakness, pt tenderness

Hawkins-Kennedy test, winged scapula test

Treatment

PRICE, decrease inflam., physician

Strengthen RC, scapular stabilizers

Prevention

RC strengthening, proper mechanics

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Rotator cuff tear

Involves supraspinatus or rupture of other rotator cuff tendons

Primary mechanism - acute trauma (high velocity rotation)

Occurs near insertion on greater tuberosity

Full thickness tears usually occur in those athletes w/ a long history of impingement or instability (generally does not occur in athlete under age 40)

Signs of Injury

Present with pain with muscle contraction

Tenderness on palpation and loss of strength due to pain

Loss of function, swelling

With complete tear, impingement and empty can test are positive

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Care

RICE for modulation of pain

Progressive strengthening of rotator cuff

Reduce frequency and level of activity initially with a gradual and progressive increase in intensity

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Shoulder BursitisEtiology

Chronic inflammatory condition due to trauma or overuse - subacromial bursa

May develop from direct impact or fall on tip of shoulder

Signs of Injury

Pain w/ motion and tenderness during palpation in subacromial space; positive impingement tests

Management

Cold packs and NSAID’s to reduce inflammation

Remove mechanisms precipitating condition

Maintain full ROM to reduce chances of contractures and adhesions from forming

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Bicipital TenosynovitisCause of Injury

Repetitive overhead athlete - ballistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath

Signs of Injury

Tenderness over bicipital groove, swelling, crepitus due to inflammation

Pain when performing overhead activities

Care

Rest and ice to treat inflammation

NSAID’s

Gradual program of strengthening and stretching

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Types of Shoulder Injuries

Tendonitis

Cause: overuse to tendons

Speed’s test

Treatment: PRICE, anti-inflammatory, rehab, etc

Prevention:

Ice post activity, conditioning, mechanics,

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Synovitis and bursitis

Cause: inflammation of synovial lining/bursa

Overuse, direct trauma

S/S: pain, crepitus, swelling, decreased mobility

Treatment: PRICE or heat, stretching pain free ROM, mechanics, etc

Prevention: mechanics