| A | B |
|---|
| Clavicle fracture | • Most common fracture in shoulder girdle o Middle third most vulnerable Signs and symptoms • Pain at affected site • Possible deformity (usually seen in a tent or triangular shape) • Decreased ROM • Athlete supports injured arm with opposite arm Treatment • Placed in sling in a comfortable position • Referred for x-rays • Depending on fracture may need to reduce if is displaced • Athlete placed in figure 8 brace which keeps shoulders back, relieves pressure on clavicle, and allows the ends of bone to reconnect properly. o Worn 6-8wks • During immobilization may being progressive strengthening and rehab •RTP in 8-12 wks |
| Humeral fracture | • Most frequent site is proximal end of bone • Epiphyseal fractures o Fractures of head of humerus most common in athletes 10 or younger when growth plate of bone has not fused to the shaft • concern is nearby arteries, vein and nerves signs and symptoms • moderate to severe pain • possible deformity • swelling and discoloration • decreased ROM treatment • splinted/sling • referred for xrays • distal neurovascular structures should be assessed both b4 and after splint is applied ensuring either the injury nor splint has compromised arteries veins and nerves • may require significant recovery time • casted and immobilized for 2 to 6 months depending on site of damage • rehab requires great deal of time bc of loss of strength and muscle atrophy that occurs with lengthy immobilization |
| scapula fracture | • moderate to severe pain • possible slight swelling and discoloration • decreased ROM • decreased strength treatment • placed in sling and referred for x-ray • progressive strengthening as soon as pain allows • rtp after 6-8 wks if proper healing has occurred |
| shoulder sprains | • injury to ligaments or joint capsule that stabilizes an supports the glenohumeral joint • occur quite often in athletics bc of frequent use and vulnerability of joint signs and symptoms • pain at shoulder joint • decreased ROM • decreased strength • slight swelling treatment • cold and electrical modality therapy and placing the athlete in sling to help minimize initial symptoms progressive Rom and strengthening allows to regain motion and promotes recovery • rtp when full range of motion and strength • may benefit from protective brace |
| shoulder dislocation/subluxation signs/symptoms and treatment | • moderate to severe pain • athlete clutches the arm to the side and supports the injured part with opposite arm • obvious deformity if joint is dislocated with a divot in skin (sulcus) where the humeral head normal is • decreased or no ROM • swelling in joint treatment • sling referred to physician for reduction if joint is dislocated • subluxation still sling and refereed for evaluation even though has reduced itself • x rays to rule out fracture of humerus or glenoid fossa • surgery may be necessary depending on severity of damage to joint structures or number of joint injuries athlete has suffered • no surgery athlete is kept in a sling, but should begin a ROM and strengthening program as soon as symptoms allow to decrease any swelling, muscle spasm, and atrophy. o Isometric and elastic band exercises relatively soon after injury o As strength improves and symptoms resolve he may be cleared to return to restricted activity o Shoulder brace for protection and support while limiting ROM • Rtp dependent on treatment option selected, the strength of the musculature, and symptoms • Surgical repair recovery is 3-4 months • No surgery normal time frame associated with joint sprain and dependent on sport |
| AC joint sprain | • 6 classifications or degrees of injury assigned a degree by number of ligaments injured and the displacement of the clavicle as a result of ligament damage • vulnerable to injury signs and symptoms • moderate to severe pain especially with shoulder motion above the dead or across the body • possible deformity-usually seen when the lateral aspect of the clavicle protrudes upward • swelling and discoloration • decreased ROM in overhead activities and horizontal adduction special tests • ac sheer test (ac compression test) o + pain or abnormal movement at AC joint • AC spring test o + pain or abnormal movement of clavicle Treatment • Sling refereed if moderate or severe sprain • Xray to rule out fracture of clavicle as complication • RICE • Surgery if damage is too severe for conservative treatment • Progressive strengthening exercises may begin as soon a tolerated RTP dependent on severity o Should be pain free with full strength, ROM and good joint stability • AC joint pads for protection |
| Labrum tears | • Labrum o Cartilaginous structure attached to glenoid fossa in shoulder o Allows a smooth surface for motion, and provides a cushion for any impacts at shoulder • Hill’s sachs lesion o An injury to the posterior lateral aspect of the humeral head • Blankart lesion o Defect in the anterior portion of the labrum o Slap lesion • An injury to the superior aspect of the labrum that extends posterior to anterior Signs and symptoms • Pain in shoulder with motion • Clicking or popping with motion • Previous history of dislocations • Loss of ROM in the specific range affected by injury location Special tests • Clunk test o + a clunk, popping, or crepitus at site of labral injury treatment • only repaired surgically • RTP dictated by rehab protocol designed for specific repair that athlete underwent |
| Brachial plexus injury | Signs and symptoms • Tingling and numbness in upper extremity to injured side • Loss of strength and ROM for 5 secs to several minutes • Possible swelling discoloration at contact Treatment • Rule out any spinal cord involvement before movement o Do cervical compression and see if it increases pain. If this is case this is more of a neck injury than brachial plexus • Have athlete flex and extend the elbow and fingers to help return of sensation • All other injuries ruled out athlete may return to play once sensation returns o Must have strength back b/c if not will not be able to protect themselves • Athlete who suffers one injury is more likely to suffer recurrent injuries • Four way neck strengthening to help prevent • Functional neck bracing for return o To prevent their head from going side to side • If athlete continues to have injury refer for evaluation for possible spinal stenosis o Is a narrowing where nerve comes out of the spinal cord and is pinching down on nerve root. Narrowing of spinal column that impinges on spinal cord |
| Rotator Cuff Strain | • Seen often in overhead athletes such as pitchers and swimmers • Often times injured because the RC is responsible for arm rotation and arm deceleration • Can be an acute or chronic injury • Most common muscle injury in shoulder Signs and symptoms • Pain in shoulder usually deep • Decreased ROM • Decreased Strength Special tests • Manuel Muscle Test- • Do for all four muscles o Have put arms out to side push down on arms and tell them not to let you • Abduction o Arms straight out o Internal external rotation pin elbow against side of them external and internally rotation • Empty can Test o Specifically to test super spinatous • Big weakness on one side means positve test • Drop arm test o Don’t to eval for a tear in any of the RC muscles o Athlete seated with arm abducted to 90 o Have athlete drop arm slowly o Positive test if athlete can’t perform test or has severe pain o Holding arms up on sides (likeT) drop slowly Treatment • RICE • Increase shoulder ROM especially UR/ER • Increase strength “red sox 7” o Flexion to 90 degrees • Arms straight out in front raise to 90 o Arms 45 degrees going up and down o Abduction adduction o Keep thumbs up through all these o 3 on table o wall pushup • Functional sport activity o Might do this with theraband at first • RTP is dependent on sport and position. Need pain free strength and ROM to return to throw • Surgery is required for RC tear (RTP 4-6 months for non throwers; 6-12 months for throwers) |
| Biceps strain | Signs and symptoms • Pain at affected site • Decreased strength • Decreased ROM • Possible deficit in muscle (Popeye deformity, lump in bicep) Treatment • RICE • ROM • Progressive strength |
| Impingement syndrome | • Involves the supraspinatus tendon of the RC • Many structures in the subacromium space where the tendon passes through • If the tendon or other structures become inflamed it cal lead to impingement • Overuse mechanism • Seen in overhead athletes Signs and symptoms • Pain and decreased rom especially with arm overhead • Decreased strength empty can test • Hawkins-Kennedy test o Horizontally adduct and internally rotate the arm o Motion forces the tendon into the coracoid process causing pain and discomfort o Is external rotation Treatment • Rest • Heat and ultrasound • NSAID’s • Increase shoulder strength • Increase • More keeps skipping slides |
| shoulder Bursitis | • signs and symptoms o pain with specific motion o possible squeaking noise with motion o possible swelling • treatment o RICE therapy with electric modalities or ultrasound o The injury may recur if biomechanical issue is not fixed |
| Muscle Tendonitis | • Signs and symptoms o Pain with specific motions o Decreased ROM and strength o May increase the risk for muscle tears • Treatment o RICE, electric modalities, ultrasound o Anti-inflammatory medicine |
| speical tests for shoulder dislocation/subluxation | • apprehension test o + test indicated by apprehension (when patient reacts to or limits motion bc of fear or sensation of impending joint dislocation or stress) in either facial expression or movements. The motion replicates the injury force of anterior dislocations • relocation test o administer after apprehension test is completed with a positive test o applies posterior force over humeral head and continues external rotation. o + if athlete’s apprehension or pain is relieved or further external rotation is possible • anterior drawer test o +increased movement, pain, or apprehension • posterior drawer o replicates motion that causes posterior dislocation o + increased posterior translation, apprehension, or instability • sulcus sign o tests for an inferior dislocation or instability o + sulcus greater than normal on injured site |
| glenoid labrum | ring of cartilage that attaches to glenoid fosssa. function=increase stabliltiy of shoulder joint by deepening glenoid cavity |
| joint capsule | ligament structure that holds the gelnohumeral jointnt together |
| muscles of rotator cuff | supraspinatus-abduction, infraspinatus-external rotation, Teres minor-external rotation, subscapulairis-internal rotation and adduction. together hold head of humerus in glenoid fossa and help with should ROM |
| ac joint injury | commoonly called separated shoulder. mechanism is downward blow to lateral shoulder or fall on outstretched arm |
| degrees of AC joint sprains | 1st: no significant damage all ligaments in tact. 2nd:mild to moderate tearing of ac ligament, little to know deformity. 3rd: complete rupture of ac and coracoaromial ligament |
| types of shoulder dislocation | 1. anterior:head of humerus dislocated anteior to glenoid is most common caused by forced abduction and external rotation. 2. posterior: humerus displaces posterior to glenoid |
