recognition of shoulder injuries treatment & evaluation standard 17 i will…describe the...
TRANSCRIPT
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 StrainsGrade 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 StrainMOI:• 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 TendonitisMOI 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
• Caused by overuse– Swim and throwing common
• Overload-walking a dog, dog keeps pulling
Acromioclavicular SprainMOI• Direct impact • Upward force
Signs & Symptoms• 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
ImpingementMOI• Compression of supraspinatus
tendon, subacromial bursa and long head of biceps tendon
• Overhead activities– Throwing– Swimming– Tennis serve– Spiking
Signs & Symptoms• Diffuse pain around acromion• Point tender over supraspinatus
or biceps tendon• Overhead Increases pain• Achy when done workout• ER weaker than IR
Glenoid Labrum TearMOI• Falling on outstretched arm• Direct blow to shoulder• Sudden pull (lift heavy object)• Throwing or weightlifters can tear
it with repetitive shoulder motion
Signs & Symptoms• Pain• Catching, clicking and/or popping• Night pain – trouble sleeping• Pain with activity• Instability• Decrease strength• Decrease ROM
Biceps TendonitisMOI• 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 ExercisesTowel Slides- flexion/extensionCodman’s- circular motion- clock & counter clock Wall finger climb - flexionPulley – active/passiveWand assist – prone flexion
StrengtheningIsometric contraction
Theraband-flexion,extension, abduction, IR, ER, SS
Dumbbell
Manual
ProprioceptiveUnstable surface
Positional changes
Shoulder Injury Exit Ticket
1. What is the purpose of the glenoid labrum?2. List the 4 joints of the shoulder complex3. List the four muscles of the RTC4. MOI of Impingement? 5. Define Frozen Shoulder and it’s MOI?6. What 2 structures give the shoulder stability?
Shoulder Do Now…1. Frozen shoulder effects what demographic the most often?2. List 2 ROM exercises.3. List the 5 RTC strengthening movements?4. Define a winging scapula5. Common complaint for a glenoid labrum tear?6. List the three bones the glenoid joint.7. MOI for AC sprain