The Shoulder Complex: Common Injury Considerations

The Shoulder Complex: Common Injury Considerations

Learning Objectives

• Recognize common injuries in the shoulder complex.
• Apply clinical reasoning to identify shoulder injuries.

Clinical Reasoning Framework for Shoulder Injuries

• Possible Structures:
  • Bone: Surgical neck of humerus fracture.
  • Joint:
  • Impingement (with or without subacromial bursitis).
  • Labral tears (e.g., SLAP tear).
  • Shoulder dislocation/instability.
  • Osteoarthritis (GHJ and ACJ).
  • Muscles/Tendons: Rotator cuff injuries (e.g., tendinopathy, tears).
  • Nerve Tissue: Includes referral patterns.
  • Non-Musculoskeletal Factors: Consider global impacts.

Common Injuries and Clinical Signs

1. Surgical Neck of Humerus Fracture

• Subjective Findings:
  • Often caused by falls (FOOSH).
  • Symptoms include severe pain, guarding, and restricted range of motion (AROM/PROM).
  • High levels of pain expected immediately after injury.
• Objective Findings:
  • Visible guarding and pain during palpation.
  • Diagnosis confirmed via X-ray.

2. Shoulder Impingement

• Subjective Findings:
  • Symptoms develop gradually; past acute incidents may be noted.
  • Painful arc during overhead elevation (60-120 degrees).
• Objective Findings:
  • Observational signs: posture abnormalities such as thoracic kyphosis.
  • Tenderness upon palpation in the greater tuberosity or bicipital groove.

3. Glenoid Labrum Injury

• Subjective Findings:
  • Often follows trauma (e.g., shoulder dislocation).
  • Pain during AROM/PROM with clicking or catching sensations.
• Objective Findings:
  • Limited range of motion, especially with abduction and external rotation.
  • MRI needed for conclusive diagnosis.

4. Shoulder Instability

• Subjective Findings:
  • Can be traumatic or result from overuse.
  • Increased apprehension in positions of extreme range.
• Objective Findings:
  • Assess through shoulder special tests; often requires MRI to rule out concurrent injuries.

5. Shoulder Osteoarthritis (OA)

• Subjective Findings:
  • Common in older adults; characterized by gradual onset and pain during activity.
  • Functionally limiting with difficulties in daily adaptive activities.
• Objective Findings:
  • Limited AROM and PROM; joint line tenderness.
  • Symptoms can vary from mechanical to inflammatory over time.

6. Rotator Cuff Tear/Tendinopathy

• Subjective Findings:
  • Present with anterior/lateral shoulder pain and acute onset following trauma (FOOSH or dislocation).
  • Tendinopathy cases arise from overuse.
• Objective Findings:
  • Pain and weakness during muscle testing, especially during abduction and external rotation.
  • Pain on specific loading patterns associated with shoulder use (e.g., lifting overhead).

Conclusion

• Recognizing clinical signs and applying a structured framework aids in diagnosing shoulder injuries effectively.
• A comprehensive understanding of subjective and objective findings is essential for accurate injury assessment and management strategies.