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Sports Injuries > Acute Shoulder > Flashcards

Acute Shoulder Flashcards

1
Q

What are the 4 pairs of ROM measured at the shoulder?

A
  • flexion/extension
  • abduction/adduction
  • internal/external rotation
  • cross flexion /extension
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2
Q

What an interchangeable term for AC joint sprain? What term does NOT describe this?

A

Separated shoulder (NOT dislocation)
- used to describe separating the acromion and clavicle in a way it shouldn’t @ AC joint

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3
Q

What are the typical causes / impacts of an AC joint sprain?

A

Direct blow to the shoulder and FOOSH

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4
Q

Define direct blow to shoulder

A

Anything where you have a direct impact on the acromion process

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5
Q

Define FOOSH

A

Fall on outstretched hand
- there is a load from impact that forces humerus up, humerus punches acromion up and forces it away from clavicle

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6
Q

What do the muscles do in response to an AC joint sprain? What problems might it cause?

A
  • Upper traps start working overtime, go into spasm
  • PROBLEM because upper traps attach onto lateral 3rd of clavicle & pull on it with contraction, irritating the joint
  • does not only show up in AC joint
  • quieting in rotator cuff
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7
Q

How does gravity have an impact in AC joint sprains?

A

-swelling could go down into armpit
- clavicle is much higher than acromion on x-ray cause it gets pulled down, separation is super irritating for ligaments trying to hold the joint together!
- drags arm down

WHY WE USE A SLING

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8
Q

In terms of pain, bruising, or swelling: what happens in ac joint sprain?

A

Swelling and bruising is pretty localized but could go down into armpit
- greenish bruising below the joint usually
- probably depends on grade of sprain?

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9
Q

What might an AC joint sprain look like?

A

Clavicle sticking up into skin, tent like appearance
+ acromion left below

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10
Q

What constitutes a type 1 acromioclavicular joint injury?

A
  • AC joint ligament damaged
  • AC joint capsule damaged (website says intact?)
  • CC ligaments INTACT
  • Nicest type, shouldn’t see big gap between clavicle and acromion

DELTOID AND TRAPS INTACT (not mentioned in lecture)

  • normal outside appearance, clavicle not elevated
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11
Q

What constitutes a type 2 acromioclavicular joint injury?

A
  • AC joint ligament : ruptured
  • AC joint capsule: destroyed
  • CC ligaments: start to see damage, sprain

DELTOID AND TRAPS minimally detached

  • widened AC joint (7mm) with 25ish % clavicular elevation
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12
Q

What characterizes a type 3 acromioclavicular joint sprain?

A

AC and CC ligaments ruptured

DELTOID AND TRAPS DETATCHED

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13
Q

Which muscles are involved in AC joint injury?

A

Anterior deltoid: comes in and attaches along undersurface of clavicle

Upper trapezius: running along upper part of the clavicle, starts to move into med traps (see a little in type 2, definitely in type 3)

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14
Q

If someone has a bony projection closer to their middle chest/sternum, what could this be?

A

SC joint issue

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15
Q

What are the main 3 types of SC joint issues you could have?

A

Sprain (some ligament damage, bones not really moved), subluxation (partial dislocation), dislocation (bones are displaced)

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16
Q

Outside of the 3 main joint injuries, what is another you might see at the clavicle? Where would this occur?

A

Fractured clavicle!
- pretty common, will fracture in area that changes shape/weaker/thinner
- lateral part of clavicle spreads out a little, transition in between medial and lateral will be where 80% of fractures occur

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17
Q

Why could a fractured clavicle and sc joint issues cause serious problems?

A
  • lungs, blood vessels (carotid), trachea, etc are behind so you might impair this with posterior dislocations of SC joint (can be life threatening)
  • brachioplexus has a ton of nerves coming together (network) under the clavicle, feeds the arm. If your hand feels strange, this could be the problem
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18
Q

What are the levels of glenohumeral instability?

A

In order from less severe to more severe:
- sprain
- subluxation (low commitment, feels like humerus shifts but doesn’t fully go out of place)
- dislocation (humerus fully comes out of joint)

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19
Q

What is the mechanism that might cause glenohumeral dislocation?

A
  • extreme external rotation, abducted shoulder, cross extension
  • takes the GH ligaments to length and damages them
  • most of the time we have anterior dislocation, humerus moves forward and inferiorly
  • can have straight down movement also
  • javelin throwing requires pitcher-like motions (external rotation and shoulder extension)
20
Q

What’s the clinical presentation for a glenohumeral dislocation?

A
  • flattening of deltoid contour
  • sticky outy thing (can see acromion from outside of skin!)
  • some bruising developing
  • arm is “just hanging there” and dead
  • sometimes people will react to this by picking up their hand to stop humerus from failing down
  • hospital visit! Needs to be pit back without catching nerve supply (sometimes after a lot of dislocations though the joint becomes very weak and they can pop it back in by themselves)
21
Q

We always have a primary injury suspect and other things involved, what other structures might be injured in with a GH dislocation?

A
  • tendons of the rotator cuff
  • supraspinatus (back)
  • infraspinatus (back)
  • subscapularis (front)
  • labrum
  • humeral head
22
Q

What movements typically dislocate the shoulder?

A
  • External rotation, abduction
23
Q

What muscle is the most pulled apart with external rotation?

A

Subscapularis
- Does internal rotation, pull it apart with external rotation (on the front)
* forgotten muscle, but one of the most vulnerable

24
Q

Where is the axillary nerve and when would it get stretched?

A

Goes through the armpit
- Get stretched with external rotation

25
Q

Define a Bankart lesion

A
  • when you think about the labrum, there are different names for different tears
  • One type of tear is called Bankart lesion/tear
  • Some types you pull off some bone too
26
Q

Which part of the labrum are you most likely to damage?

A
  • anterior and inferior
  • If humourous goes down, it might take some of labrum with it on the bottom
  • Up to 80% of first time dislocators are going to have a Bankart lesion of some kind
27
Q

Define Hill-Sachs

A
  • Compression fracture of humeral head
  • Your bone isn’t totally solid, when crushed it could collapse in on itself
  • Like snowball “ compresses”
  • Humorous goes forward, as it goes back at slams up against interior room of the glenoid fossa = Compression
  • Tension with passive and active structures will try to put it back but it doesn’t land in right spot
  • secondary lesion on posterior side of shoulder where dent is, about 50% of dislocators will have this
28
Q

What structures could be damage when you have an AC joint sprain?

A
  • some deltoid at attachment to bone
  • Upper traps at attachment to bone
  • AC ligament
  • CC ligaments
  • Brachioplexus
  • joint capsule for AC joint
29
Q

Which range of motion tests are least likely to be painful with an AC joint sprain?

A
  • Internal and external rotation
  • Doesn’t really involve scapula or clavicle, just spins humerus in glenoid fossa
  • Requires least amount of contribution of shoulder girdle
30
Q

Which structures can be damaged when you dislocate anterior GH joint?

A
  • anterior inferior labrum
  • axillary nerve
  • Head of humerus
  • Glenohumeral ligaments: subscap
  • Tendons of rotator cuff
    Lots of options***
31
Q

Which range of motion would mostly likely be painful following an anterior GH dislocation (three major ones)

A
  • external rotation
  • Cross extension
  • Abduction
  • the ones that reproduce the mechanism of injury
32
Q

Which range of motion tests are most likely to be painful with an AC joint sprain?

A
  • The ones that ask shoulder girdle to contribute the most: process of elimination!
  • FLEXION (SAGITTAL): when you raise your arm shoulder girdle, has to do elevation. If you try to raise arm up through flexion, will require shoulder girdle to go up. Most muscles attach the schedule and lift it, so elevation cause issues
  • CROSS FLEXION: shoulder girdle protracts, scapula goes forward. He isn’t always most annoying thing because you’re bringing it in close together.
  • CROSS EXTENSION: YES! Shoulder griddle retracts, and pulls scapula away from clavicle
  • ABDUCTION: Shoulder won’t like this
  • ADDUCTION: starting from neutral, won’t see much. But on return from abduction might be uncomfortable
33
Q

Describe the paxino’s sign special test

A
  • for AC joint
  • If we want to check the integrity of AC joint, we squeeze, clavicle and scapula together in front to back way
  • Two fingers on clavicle, thumb on scapula
  • Trying to push acromion forward to create shearing force
  • If you have an intact AC, this won’t feel like much, if you have an injury, this will feel very uncomfortable
  • When you come by this with O’Brien’s test and they’re both positive, this can help you nail down the AC joint
34
Q

What does the O’Brien’s test look for?

A
  • primarily test for a labrum (labral lesion) but her side benefit of being irritating to AC joint as well
  • Internally rotated position, cross flexed, meets resistance
35
Q

Describe the apprehension relocation test

A
  • tests for anterior GH joint instability
  • If you dislocated shoulder, don’t try it
  • Abduct and externally rotate, repeat mechanism of injury
  • Apprehension= uncomfortable feeling, feels like you’re starting to approach end range/nervous
  • If you take hand and apply the palm of hand against front of humor, so it doesn’t pop out and they feel better, this means we have an anterior instability of the joint (relocation)
36
Q

How long does a grade one AC sprain recovery take?

A

Roughly 4 weeks

37
Q

How long has a grade 2 AC sprain take to recover?

A

Roughly 8 weeks

38
Q

How long does a grade 3 AC sprain, take to recover?

A

Roughly 12 weeks

39
Q

Describe sling use for AC sprains

A
  • Gravity is always trying to pull AC joint apart
  • Usually don’t need to be in it more than 10 days, until comfortable
40
Q

Biologically why does a sling help AC sprain recovery

A

Trying to lay down collagen and get it to mature takes a while, especially if gravity is pulling apart granulation tissue

41
Q

What happens after the first three grades of AC sprain recovery?

A

Three grades of surgery
- After this, we have surgery and more extensive recovery

42
Q

What happens to sprain symptoms with recurrent instability?

A
  • When we dislocate we can damage labrum and ligaments
  • sometimes it doesn’t heal well and stay loose so people get this more often
  • Eventually they don’t really damage anything so it hurts less after a lot of times, just “ comes out”
43
Q

Who is at a higher risk for recurrent instability

A
  • males
  • People under the age of 40
    -Hyper laxity (what term you apply to your whole body when you have an incredible amount of ROM, baseline is already loose and low stability)
44
Q

Where does hyper laxity come from??

A
  • Can we born with it or get it from sports like dance and gymnastics
45
Q

What effect does sling duration have on recurrence?

A
  • sling time for GH joint has been long discussed, found that there isn’t much benefit between one week in swing in three weeks in swing
  • GH dislocation sling time is shorter than we once thought
46
Q

What does recurrence like in operative versus non-operative patients?

A

One of the solutions for dislocation is to go to surgery so the joint can be tightened in someway
- recurrent sprains happened and 47% of nonoperative patients and 6% of operative patients
- You might be more careful that recovery after surgery, think they’re risking more
- Won’t be a solution for everyone though

47
Q

Describe brace use in shoulder injuries

A
  • A little research has been done on which position people should be immobilized in
  • You can use a bracelet looks them into a position if you have the financial means to do so
  • Immobilize with hand across torso like classic sling
  • Immobilize at 15° of external rotation
  • The benefit in recurrence was pretty much just in 20 to 40 years old. For younger people, it didn’t matter.

Er vs IR immobilization recurrence rate risk ratio = 0.56

Sports Injuries (21 decks)

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