Ch. 22: The Shoulder Complex

what does FOOSH stand for?

Fall Onto Out-Stretched Hand

where do clavicular fractures typically occur?

middle 3rd of the clavicle

etiology of a clavicle fracture

FOOSH, fall of shoulder tip

presents with supporting of arm and structure lowering is a Sx and Sy of what injury?

clavicular fracture

what happens if you’re palpating and the athlete is in too much pain for you to do your job?

send them to the hospital after slinging and swath bandaging their injury

direct impact or force transmitted up through humerus is the etiology for what?

scapula fracture

when should you begin overhead strengthening for a scapular fracture patient?

week one

what is the basic treatment for most shoulder fracture injuries?

slinging or bandaging

sling vs swathe?

slings support, swathes restrict

where do proximal humerus fractures occur?

surgical neck of the humerus on up

etiology of humeral shaft fractures?

direct blow or FOOSH

direct/indirect blow traveling along long axis humerus is the etiology of which injury?

epiphyseal humerus fracture

proximal humerus fractures a risk for…?

nerve or blood supply damage

is a backwards or forwards clavicular fracture more dangerous and why?

a backwards fracture because it can puncture the trachea or other important structures

an impact to where increases the likelihood of an anterior displacement of the clavicle

impact to the side of the shoulder

pain, subluxation with deformity, swelling, and decreased ROM with possible life-threatening dislocation are the Sx and Sy of which injury?

grade II sternoclavicular sprain

pain and slight disability are Sx and Sy of which injury?

grade I sternoclavicular sprain

how many grades of acromioclavicular sprains are there?

6

etiology of acromioclavicular sprain?

direct blow from any direction or upward force from humerus or fall on shoulder

which grade of an AC sprain is this?: point tenderness and pain with movement; no disruption of AC joint

grade I

grade IV, V, and VI AC sprains all require which Tx?

surgery

what is a piano key sign?

palpating the clavicle along the AC and CC joints and finding a divot - happens with grade III AC sprains

which grade of an AC sprain is this?: tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness, and decreased ROM

grade II

which grade of an AC sprain is this?: rupture of AC and CC ligaments; positive piano key sign

grade III

forced abduction and/or external rotation cause which injury?

anterior glenohumeral joint sprain

forced adduction and/or internal rotation cause which injury?

posterior glenohumeral joint sprain

what is something to keep in mind when treating joint sprains?

potential development of chronic conditions due to ligament stretching

pain during movement (especially when recreating MOI) and decreased ROM and pain with palpation are Sx and Sy of which injury?

glenohumeral joint sprain

excessive translation of humeral head without complete separation is the etiology for which injury?

shoulder subluxation

severe pain, deformity, carrying arm at awkward angle, and cradling arm are Sx and Sy of which injury?

shoulder sublux/dislocation

Tx for shoulder sublux/dislocations

splint, check circulation and sensation, assess for soft tissue damage

what is a Bankart lesion and what causes it?

permanent anterior defect of labrum caused by shoulder dislocation (SD)

what is a Hill-Sachs lesion and what causes it?

divot in humeral head due to SD causing compression of bone against anterior glenoid rim

what is a SLAP lesion and what causes it?

Superior Labrum Anterior and Posterior; defect in superior labrum that begins posteriorly and extends anteriorly where biceps tendon anchors to the labrum due to a SD

what are other complications of SD?

• brachial nerves and vessels may be compromised

• rotator cuff injuries

• fractures

• bicipital tendon subluxation and transverse ligament rupture

what does the Yergesen’s test palpate?

bicipital groove

what causes chronic instability of the shoulder

supporting tissue becomes more lax increasing mobility and damaging other soft tissue structures

clicking or pain; apprehension with external rotation and abduction are Sx and Sy of which injuries?

anterior chronic instability

possible impingement, loss of internal rotation; increased laxity; pain anteriorly and posteriorly are Sx and Sy of which injury?

posterior chronic instability

inferior laxity, possible Sx and Sy associated with anterior and posterior instability are signs and symptoms of which injury?

multidirectional chronic instability

what to avoid while treating chronic instability conditions?

mobility

etiology of shoulder impingement

mechanical compression of supraspinatus, subacromial bursa, and long head of biceps tendon due to decreased space under coracoacromial arch

• seen in OH repetitive activities

what are some exacerbating factors for shoulder impingements

Kyphotic posture and rounded shoulders - twists scapula out of place

increased glenohumeral external rotation gain (ERG) and decreased glenohumeral internal rotation (GIRD); pain on subacromial space palpation, and pain with OH motions are Sx and Sy of which injury?

shoulder impingement

what is the painful arc?

pain with 60-120 degree abduction of the shoulder indicating impingement syndrome

where do rotator cuff tears occur?

near insertion on greater tuberosity if supraspinatus

• lower tuberosity if ITS

who is most susceptible to full-thickness rotator cuff tears?

athletes over 40 with long history of rotator cuff injury

decreased ROM and strength, decreased tolerance for ADLs, and pain and loss of function are Sx and Sy for which injury?

rotator cuff tear

what is scapular dyskinesis

abnormal movement of the scapula

what is a SICK scapula

seen in scapular dyskinesis

• Scapular malposition

• Inferior medial scapular swinging

• Coracoid tenderness

• Kinesis abnormalities of the scapula