Chapter 17 Shoulder Conditions

Question 1

What is the MOI for an SC joint sprain?

Answer 1

compression related to a direct blow, indirect forces transmitted from a blow to the shoulder or a fall on an outstretched hand

Question 2

What is the SC joint?

Answer 2

main axis of rotation for movements of the clavicle and scapula
sternoclavicular joint

Question 3

What is a grade 1 SC joint sprain?

Answer 3

point tenderness, mild pain, no visible deformity

Question 4

What is grade 2 SC joint sprain?

Answer 4

joint subluxation that leads to bruising, swelling and pain, unable to horizontally adduct the arm without considerable pain

Question 5

What is a grade 3 SC joint sprain?

Answer 5

displacement of sternal end of clavicle, may involve a fracture, complete rupture of SC and costoclavicular ligaments

Question 6

How is the acromioclavicular joint injured?

Answer 6

Weak and easily injured by a direct blow, fall on the point of the shoulder or force transmitted up the long axis of the humerus during a fall with the humerus in an adducted position

Question 7

What is a type 1 AC joint sprain?

Answer 7

stretch or partial damage of the AC ligament and capsule

Question 8

What is a type 2 AC joint sprain?

Answer 8

rupture of AC ligament and partial strain of coracoclavicular ligament

Question 9

What is a type 3 AC joint sprain?

Answer 9

rupture of AC ligament and coracoclavicular ligament

Question 10

What is a type 4-5 AC joint sprain?

Answer 10

rupture of AC ligament and coracoclavicular ligament and tearing of deltoid and trapezius fascia

Question 11

What MOI results in a glenohumeral joint sprain?

Answer 11

forcefully abduct the shoulder, excessive shoulder ER and extension, direct blow or forceful movement

Question 12

What is a first degree GH joint sprain?

Answer 12

First-degree – POP anterior shoulder and movement, AROM slightly limited

Question 13

What is a second-degree GH joint sprain?

Answer 13

some joint laxity, pain, swelling, bruising, ROM limited especially abduction

Question 14

What MOI results in anterior instability?

Answer 14

MOI – blow to the posterolateral shoulder, excessive indirect forces that push arm into abduction, ER and extension

Question 15

What are the S/S of anterior instability?

Answer 15

S/S – laxity in middle and inferior GH joint ligaments, vague pain, inability to sleep on it, clicking, positive shoulder apprehension test, anterior load and shift

Question 16

What is a bankart lesion?

Answer 16

Inferior ligament avulsed from anterior lip of labrum or in combination with a portion of the labrum

Question 17

What MOI results in posterior instability?

Answer 17

MOI – posterior force is directed along the long axis of the humerus with the humerus flexed and internally rotated
Excessive glenoid retroversion and increased IR and ER strength

Question 18

What is inferior instability of the shoulder?

Answer 18

Rare
Primary restraint against inferior translation – superior GH ligament

Question 19

What is multidirectional instability of the shoulder?

Answer 19

Damage takes place in more than one plane
Anterior and posterior dislocations are associated with some pre-existing inferior laxity

Question 20

What are GH dislocation and subluxations?

Answer 20

Most frequently dislocated major joint in the body
90% anterior dislocations
Acute – associated fracture or nerve damage, 911
Muscle spasm
Chronic – anterior dislocations that are intracapsular, forces needed to produce injury decrease, dead arm syndrome

Question 21

What is the glenoid labrum?

Answer 21

Glenoid labrum – fibrocartilaginous rim that lines the glenoid fossa to better receive the humeral head

Question 22

What is a SLAP lesion?

Answer 22

SLAP lesion – injury to superior labrum that begins posteriorly and extends anteriorly, disrupting the attachment of the long head of the biceps

Question 23

What are the general S/S of glenoid labrum tears?

Answer 23

S/S – catching, clicking, weakness in OH, speed’s/yergason’s may be positive as well

Question 24

What are rotator cuff and impingement injuries?

Answer 24

Repetitive micro traumatic episodes that primarily impinge on the supraspinatus tendon just proximal to the greater tubercle of the humerus
Chronic tears – thinning, degeneration, total rupture
Impingement – actual, mechanical abutment of the rotator cuff and subacromial bursa against the coracoacromial ligament and acromion
Painful arc

Question 25

What is a shoulder bursitis?

Answer 25

Not generally an isolated condition, associated with an impingement Large subacromial bursa – located between coracoacromial ligament and supraspinatus muscle, provides gliding ability Becomes impinged during OH movements

Question 26

What are the S/S of shoulder bursitis?

Answer 26

S/S – shoulder pain during initiation and acceleration of throwing motion, painful arc 70-120 degrees abduction, pain with sleeping, referred pain to deltoid tuberosity

Question 27

What is the management for a shoulder bursitis?

Answer 27

Referral to physician – inject corticosteroid solution into subacromial space to relieve symptoms

Question 28

What is a bicipital tendinitis?

Answer 28

Repetitive overuse during rapid OH movements involving excessive elbow flexion and supination activities Irritation of the tendon occurs as it passes back and forth in the intertubercular groove of the humerus Tendon may sublux due to laxity at transverse ligament S/S – pain in bicipital groove during IR and ER of shoulder

Question 29

What is Thoracic Outlet Compression syndrome?

Answer 29

Nerves and/or vessels become compressed in the proximal neck or axilla Neurological  90%, involves lower trunk of brachial plexus, caused by abnormal nerve stretch or compression Vascular form  subclavian artery and vein, men > women OH rotational activities S/S – NTB, heaviness/coolness down arm, weakness in extremities

Question 30

What is atraumatic osteolysis and what are its S/S

Answer 30

Atraumatic osteolysis – distal clavicle is an overuse injury resulting from repetitive microtrauma, follows traumatic injury to the distal clavicle S/S – dull ache over AC joint, worse at the beginning of exercise, pain and weakness in flexion and abduction, crepitus, radiographs show osteopenia

Question 31

What is a traumatic clavicular fracture and what are its S/S?

Answer 31

Traumatic clavicular fracture – nearly 80% of traumatic fractures occur in the middle third of the clavicle, SCM pulls bone upwards S/S – swelling, ecchymosis and deformity

Question 32

What is a scapular fracture?

Answer 32

Body of scapula, spine of scapula, acromion process, coracoid process or GH joint Avulsion fractures of coracoid process – direct trauma or forceful contraction of the pectoralis minor or short head of biceps GH area – associated with subluxations and dislocations

Question 33

When does the medial clavicular growth plate close?

Answer 33

not before 25 y/o

Question 34

What is a Little league shoulder?

Answer 34

Proximal humeral epiphysis doesn't close until 18-21 years old, a fracture at this site is known as little league shoulder

Question 35

What MOI results in epiphyseal and avulsion fractures?

Answer 35

repetitive medial rotation and adduction traction forces

Question 36

What are the S/S of epiphyseal and avulsion fractures?

Answer 36

deep palpation of axilla increase pain, pain with throwing hard

Question 37

What are humeral fractures?

Answer 37

Result from violent compression forces from a direct blow, a fall on the upper arm or a FOOSH Surgical neck most common site, appear as dislocated

Question 38

What are the S/S of humeral fractures?

Answer 38

S/S – paralysis, pain, swelling, hemorrhage, discolouration