Sports Related Upper Extremity Injury (copy)

Which of the glenohumeral ligament is MOST often torn

INFERIOR GHL (anterior band) → restraint in anterior-inferior translocation at 90 degree abduction and ER

What causes acromioclavicular joint separation

Fall/tackle lateral point of shoulder while arm is ADDucted → rupture of AC ligament → rupture CC ligament and trapezoid → see piano key sign and positive Scarf test

Which Rockwood types need OPERATIVE treatment

IV up → need to reconstruct CC ligament after AC injury

This deformity is called what and what injury causes it

Piano key sign → acromioclavicular joint separation

What causes TUBS

Forced ADDuction + ER

What lesions are found in anterior shoulder dislocations (TUBS)

Bankart = avulsion of anteroinferior glenoid labrum

Hill Sach = posterolateral humeral head compression/impaction fracture

In anterior shoulder dislocation what nerve injury are you MOST concerned about

Axillary nerve (C5-C6) → check lateral deltoid before AND after reduction

What direction of shoulder dislocation is most common

Anterior »»»» Posterior (95% > 5%)

What is Superior Labrum Anterior-to-Posterior (SLAP) tear

Injury to upper glenoid labrum → Snyder Grade II involve bicep long head

Features of TUBS arm posture

Slight ABDuction + external rotation + flat deltoid → positive Apprehesion and Jobe

What causes of traumatic posterior dislocation

Flexion + ADDuction + IR; Epileptic seizure, electrocution or ethanol trauma

Traumatic posterior shoulder dislocation arm posture

LOCKED IN IR (cannot ER) + prominent posterior humeral head

What is Neer stages

Used for subacromial impingement

Stage 1 <25 → reversible edema and hemorrhage

Stage II 25-40 → fibrosis and tendinopathy

Stage III >40 → bone spur and tendon rupture

What is frozen shoulder

Synovial inflammation caused by change from type III into type I collagen → contraction of rotator, CHL, inferior glenohumeral capsule; common in 40-60 y/o female and DM

What hallmark PE findings prefer frozen shoulder > rotator cuff tear

Loss of BOTH active AND passive ROM; ER → ABDuction → IR + NORMAL shoulder x ray

What is pre freezing phase of frozen shoulder

Synovitis → aching nocturnal pain → treat with kenacort and lidocaine + pendulum exercise

What is freezing phase of frozen shoulder

Synovitis + progressive capsular thickening → severe pain + active and passive ER, ABDuction, IR loss → treat with hydrodilatation and lidocaine

What is frozen phase of frozen shoulder

Acellular collagenous fibrosis → pain subside + rock hard stiff → treat with deep heat followed by end range stretching

What is thawing phase of frozen shoulder

Capsular remodeling and return of ROM

What if calcific tendinopathy of rotator cuff

Calcium hydroxyapatite crystals inside supraspinatus tendon

What is scapular dyskinesis

SICK scapula = Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition (pec minor cause this) Kinesis abnormal

Confirmatory bedside test for scapular winging

Scapular Assistance Test (SAT) → Assisted upward rotation and posterior tilt in arm elevation → doing this should decrease pain + improve abduction

Scapular retraction test (SRT) → stabilize medial border against ribs during Jobe → positive if supraspinatus strength improve

What is MEDIAL scapular winging

Long thoracic nerve (C5-7) lesion → Serratus anterior paralysis see medial border move MEDIALLY toward spine

Causes of MEDIAL scapular winging

Blunt chest trauma, heavy rucksack (Backpack palsy), Parsonage Turner

Provocative test for MEDIAL scapular winging

Forward flexion and wall push up test; manage by observe and PT

What is Trapezius palsy

Spinal Accessory nerve lesion → trapezius palsy → LATERAL scapular winging; medial border moves LATERALLY from spine; ipsi shoulder droop down

What causes Trapezius palsy

Iatrogenic injury during posterior cervical triangle lymph node biopsy

Provocative test for Trapezius/ LATERAL scapular winging

Shoulder abduction against resistance

What is rhomboid palsy

Dorsal scapular nervy lesion → Rhomboid paralysis (major and minor) = LATERAL scapular winging

Causes of rhomboid palsy

C5 root lesion, scalene hypertrophy, overhead traction

Provocative test for Rhomboid/LATERAL scapular winging

Lowering arms from forward elevation or push elbow backward against resistance

What muscles are TIGHTENED in Text neck/UPPER crossed syndrome

• Dorsal Proximal: Suboccipitals, Upper Trapezius, Levator Scapulae (+ SCM)

• Ventral Distal: Pectoralis Major & Pectoralis Minor

What muscles are WEAKENED in Text neck/UPPER crossed syndrome

• Ventral Proximal: Deep Cervical Flexors (Longus Colli & Longus Capitis)

• Dorsal Distal: Middle Trapezius, Lower Trapezius, Rhomboids & Serratus Anterior

Posture of Upper Crossed syndrome

Forward head posture, rounded shoulder, kyphosis, scapular dyskinesis, subacromial impinge, TOS

What muscles are TIGHTENED in LOWER crossed syndrome

• Dorsal Proximal: Thoracolumbar Erector Spinae & Quadratus Lumborum

• Ventral Distal: Iliopsoas & Rectus Femoris (Hip Flexors)

What muscles are WEAKENED in LOWER crossed syndrome

• Ventral Proximal: Deep Abdominals (Transversus Abdominis, Internal/External Obliques, Rectus Abdominis)

• Dorsal Distal: Gluteus Maximus & Gluteus Medius

Posture in LOWER crossed sydnrome

Anterior pelvic tilt + lumbar hyperlordosis, facet joint overload, spondylolisthesis shear, hamstring strain

Rehab for crossed syndrome

Release the tight muscle, strengthen the weak muscles

What is Colles’ fracture

FOOSH injury on EXTENDED wrist → fracture of DISTAL RADIUS

Management of Colles’ fracture

Hematoma block → aspirate hematoma → closed reduction → immobilization → open reduction and internal fixation with volar lock plate if unstable

Complications of Colles’ fracture

CTS, delayed EPL tendon rupture (common in non displaced), CRPS type I

What is this

Dinner fork deformity → sign of COLLES fracture

This splint is used for what fracture

Sugar tong splint → COLLES fracture

How does Mallet finger differ from Jersey finger

Mallet is damage to EXTENSOR hood

Jersey is damage to FLEXORS (FDP)

How does management differ from Mallet finger and Jersey

Mallet → SPLINT; K wire only if severe

Jersey → SURGERY (tendon reinsertion); splint DOES NOT help

What is Skier’s/Gamekeeper’s thumb

Tear of 1st MCP ulnar collateral ligament → thumb is in forced abduction + radial deviation

What stage of carpal tunnel needs surgery

Moderate → if night splint and corticosteroid fail and severe cases

How does Cubital tunnel differ from Guyon canal

BOTH affect dorsal ulnar cutaneous → Cubital has numbness in volar AND dorsal ulnar hand (4-5th digit); Guyon is numbness in volar ONLY

What is thoracic outlet syndrome

Compression of BRACHIAL PLEXUS and subclavian artery at the interscalene triangle

What is neurogenic TOS

Compression of LOWER trunk (C8-T1) → numb medial forearm and ulnar hand, wasting of APB, hypothenar, interossei (Gilliatt Sumner Hand)

What is ganglion cyst

Cyst of the hand and wrist → resolve and recur and are normally ASYMPTOMATIC → remove only if they start affecting daily life