Shoulder unit

Shoulder injury risk

High mobility = low stability; repetitive stress

FOOSH(A)

Fall on outstretched hand/arm

Clavicle

S-shaped, supports arm, fractures easily

Scapula

Flat, triangular

Humerus

Head, bicipital groove

Clavicle fx

Most common; FOOSH/direct hit; swelling, deformity; sling

Humeral shaft fx

Blow/fall; pain, swelling; splint

Proximal humerus fx

Risk nerves/vessels; fall/blow

Epiphyseal fx

Kids; force along bone

Piano key test

AC joint injury

Shoulder dislocation

50% of all; 85-90% recur

Subluxation

Partial dislocation

Anterior dislocation

Most common; ABD + ER; flat deltoid; immobilize

Posterior dislocation

Add + IR; limited ER; immobilize

SC joint

Clavicle + sternum; only UE-trunk link

AC joint

Clavicle + acromion; weak

GH joint

Ball/socket; labrum + RC support

Scapulothoracic

Not true joint

SC ligament

pull clavicle down and towards the sternum

AC sprain MOI

Fall on shoulder

Grade 1 AC joint sprain

Mild stretch, no deformity

Grade 2 AC joint sprain

Partial tear, some displacement

Grade 3 AC joint sprain

Full tear, deformity

AC tx

Sling, tape, possible surgery

GH sprain

ABD + ER or blow; pain, ↓ROM; rehab

Flexion

Ant deltoid, biceps

Extension

Post deltoid, triceps

Abduction

Deltoid

Adduction

Lats, teres major

ER

Teres minor, supraspinatus

IR

Subscapularis

Horiz add

Pec major

Horiz abd

Post deltoid

Protraction

Serratus anterior

Retraction

Rhomboids

Depression

Pec minor, trap

Elevation

Trap, levator scap

Bicipital tenosynovitis

Overuse; ant shoulder pain; rest/NSAIDs

Impingement

Supraspinatus; overhead pain; PRICE

Bursitis

Overuse/impact; pain w/ movement; PRICE

Subacromial bursa

Most compressed w/ overhead

Blood supply

Subclavian, axillary, brachial

Thoracic Outlet Syndrome (TOS)

Compression of brachial plexus/vessels; causes arm heaviness or grip weakness.

Night pain

Primary indicator of a Rotator Cuff Tear.

Burning pain

Indicator of Acute Tendinitis.

Piano Key Test

Pain/laxity at distal clavicle = AC Sprain or Clavicle Fracture.

Compression/Squeeze Test

Squeezing clavicle/scapula causes pain = AC Sprain.

Sulcus Sign Test

Observable gap in deltoid when pulling arm down = GH Joint Sprain.

Apprehension (Crank) Test

Resistance/fear during passive external rotation = GH Joint Sprain.

Yergason's Test

Pain during resisted supination = Biceps Tendinitis.

Speed's Test

Pain in bicipital groove during resisted flexion = Biceps Tendinitis.

Drop Arm Test

Inability to slowly lower arm from 90° = Supraspinatus Weakness.

Empty Can Test

Pain/weakness with resisted flexion in IR = Supraspinatus Weakness.

Neer's Test

Pain during passive shoulder flexion = Shoulder Impingement.

Hawkin's-Kennedy Test

Pain with internal rotation at 90° flexion = Shoulder Impingement.

Step Deformity

High clavicle/low shoulder anteriorly = ACJ Dislocation.

Flat Deltoid

Flattened shoulder appearance = Anterior Dislocation.

Scapular Winging

Scapula lifting off ribs during movement = Weakness/Nerve pathology.