Transcript ATC 222 - Missouri State University

ATC 222
Chapter 21
The Shoulder
Complex
Anatomy

Bones
– clavicle
– humerus
– scapula
Ligaments
Sternoclavicular
 Acromioclavicular
 Glenohumeral

Muscles

Rotator Cuff
– S.I.T.S.
– surrounding musculature
Nerve Supply

Brachial Plexus C5-T1
Blood Supply
Subclavian Artery
 Axillary Artery
 Brachial Artery

Shoulder Assessment

H.O.P.S.
– History
– Observation
– Palpation
– Special Tests
Recognition &
Management of
Specific Injuries
Fractures
Clavicular
 Humerus
– Shaft
– Proximal
– Epiphyseal

Clavicular Fractures
Etiology
– fall on outstretched arm or tip of
shoulder
– direct impact
 Signs and Symptoms
– supports the arm on the injured side
tilting the head toward that side and
the chin opposite

Clavicular Fractures

Management
– apply sling and swathe
– refer for x-ray
– immobilize 6-8weeks
Humeral FracturesShaft
Etiology
– direct blow or fall on the arm
 Signs and Symptoms
– probable deformity
– wrist drop and inability to supinate
the wrist

Humeral FracturesShaft

Management
– splint and referral to a physician
– 3-4 months
Humeral FracturesProximal
Etiology
– direct blow, fall on outstretched arm,
or dislocation
 Signs and Symptoms
– often mistaken for a shoulder
dislocation
– possible severe hemorrhaging

Humeral FracturesProximal

Management
– sling and swathe and referral
– 2-6 months
Humeral FracturesEpiphyseal
Etiology
– direct blow or indirect force along the
axis of the humerus
 Signs and Symptoms
– shortening of the arm
– appearance of a false joint
 Management
– splint and referral to a physician

Sprains
Sternoclavicular
 Acromioclavicular
 Glenohumeral;

Sternoclavicular
Sprain
Etiology
– indirect force transmitted through the
humerus
– twisting of an posteriorly extended
arm
 Signs and Symptoms
– Grade 1
– Grade 2: visible deformity and
inability to abduct arm

Sternoclavicular
Sprain
– Grade 3: complete dislocation, if
posterior, it’s a MEDICAL EMERGENCY
Sternoclavicular Sprain

Management
– RICE
– reduction, immobilization 3-5weeks
Acromioclavicular
Sprain

Etiology
– direct impact to tip of shoulder
– upward force against long axis of
humerus, falling on outstretched arm
Acromioclavicular
Sprain

Signs and Symptoms
– Grade 1:
– Grade 2: prominent lateral end of
clavicle, unable to completely abduct
or horizontally adduct
– Grade 3: rupture the AC and
Coracoclavicular ligaments resulting
in a dislocation of clavicle, very
prominent distal clavicle
Acromioclavicular
Sprain

Management
– apply ice and sling and swathe
– referral
– Grade 1: 3-4 days
– Grade 2: 10-14 days
– Grade 3: 2 weeks, Operative vs. Nonoperative
Glenohumeral Joint
Sprain
Etiology
– forceful abduction and ER
– forceful movement posteriorly with
flexion of arm
 Signs and Symptoms
– decreased ROM
– pain with reproduction of mechanism

Glenohumeral Joint
Sprain

Management
– ice and sling for comfort
– initiate active and passive ROM after
1-3 days
Acute Subluxations &
Dislocations
accounts for up to 50% of all
dislocations
 only 1-4% are posterior
 85-90% recur

Glenohumeral
Dislocations-Anterior

Etiology
– direct impact on posterolateral or
posterior aspect of shoulder
– forced abduction and ER
Glenohumeral
Disloccations-Anterior

Signs and Symptoms
– flattened deltoid contour
– humeral head in the axilla
– arm carried in slight abduction and
ER
Glenohumeral
Dislocations-Anterior

Management
– immobilize in sling and application of
ice
– referral to a physician for reduction
and x-ray
– DO NOT attempt to reduce
Glenohumeral
Dislocation-Posterior
Etiology
– forced adduction and IR
– fall on extended and internally
rotated arm
 Signs and Symptoms
– arm held in adduction and internal
rotation
– head of humerus may be seen
posteriorly

Chronic Shoulder
Instabilities
Etiology
– traumatic (micro vs. macro),
atraumatic, congenital, and
neuromuscular
 Signs and Symptoms
– Anterior
– Posterior
– Global

Chronic Shoulder
Instabilities

Management
– Conservative vs. Surgical
– shoulder harness
Shoulder Impingement
Syndrome

Etiology
– repetitive overhead activities
– capsular laxity leading to
inflammation
– forward head and rounded shoulders
– hooked shaped acromion process
Rotator Cuff Tears
partial thickness vs. complete thickness
tears
 acute trauma or impingement
 nearly always involves the
supraspinatus muscle

Shoulder Impingement
Syndrome

Signs and Symptoms
– diffuse pain around the acromion
– pain with overhead activities
– weak external rotators
Shoulder Impingement
Syndrome
Stage I
– aching after activity
– pain with abduction that becomes
worst at 90 degrees
– pain with flexion and resisted
supination and external rotation
 Stage II
– aching during activity that becomes
worst at night, restricted movement

Shoulder Impingement
Syndrome

Stage III (25-40)
– pain during activity with increase pain
at night
– possible muscle tear and permanent
thickening of rotator cuff & bursa
– scar tissue
Shoulder Impingement
Syndrome

Stage IV (40+)
– infraspinatus and supraspinatus
wasting
– a lot of pain with abduction to 90
– limited AROM and PROM
– weakness during abduction and ER
Shoulder Impingement
Syndrome

Management
– RICE
– Modification of activity
– Strengthening of ER and Scapular
Stabilizers
– Surgery vs. Injection
Shoulder Bursitis
Etiology
– fall on tip of shoulder
– direct impact or shoulder
impingement
 Signs and Symptoms
– pain with abduction, flexion and IR
 Management
– cold, antiinflammatory medications

Bicipital Tenosynovitis
Biceps Brachii Rupture
Peripheral Nerve
Injuries
Etiology
– blunt trauma or stretch
 Signs and Symptoms
– constant “burning” pain, muscle
weakness and atrophy
– paralysis

Peripheral Nerve
Injuries

Management
– ice
– resume play when symptoms subside
– referral to a physician is ESSENTIAL if
symptoms persist
Thoracic Outlet
Compression
Syndrome

Etiology
– compression of brachial plexus,
subclavian artery and vein
(neurovascular bundle)
– compression by the scalene and
pectoralis mucles
Thoracic Outlet
Compression
Syndrome

Signs and Symptoms
– paresthesia and pain
– impaired circulation in the fingers
– muscle weakness and atrophy
Thoracic Outlet
Compression Syndrome

Management
– stretching of pectorals and scalenes
– strengthening of the traps,
rhomboids, serratus anterior