Exam 2 Injury Flashcards by Allison Buckley

shoulder subjective

what happened
hurts?
how long?
quality of pain?
previous history
alleviates/aggravates
numbness/radiating
dominant arm
same as throwing/hitting arm
noticeable muscle weakness
what activities cause instability

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shoulder objective

discoloration/deformity/swelling
muscle tone/ atrophy
dominant arm
symmetry/ scapular winging
posture/sprengei deformity/ step deformity
scars
arm position/ vertebral alignment
palpation starts at SC joint 
point tenderness, crepitus,

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order of shoulder objective

palpation
joint and muscle assessment
apley scratch
special tests
neurological assessment
vascular assessment

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order of special tests

instability
SLAP
tendnopathy
thoracic outlet
scapular dyskinesis

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sternoclavicular joint sprain

subjective

FOOSH or lateral force; sometimes traction
force; receiving an anterior blow to clavicle with
shoulder in extension; c/o pain over joint, may
experience paresthesia in upper extremity due
to swelling/compression

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sternoclavicular joint sprain

objective

swelling over jt; deformity if dislocated;
maybe discoloration; pt tend; sometimes
crepitus; AROM painful c abd (@ end
ROM), flex &amp;/or horiz abd,
protraction/retraction; + SC Glide test

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sternoclavicular joint sprain

plan

immobilize; ice, ROM leading to strength

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Acromioclavicular Joint Sprain

subjective

FOOSH in flex or direct blow; pain over

AC jt, lat deltoid &/or lat neck

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Acromioclavicular Joint Sprain

objective

: Pt tend AC jt; may have step deformity;
AROM dec c flex, horiz add & motions
above 90 degs; PROM same results;
RROM dec due to pain; + Crossover, +
Piano Key, + Traction, + Apley’s Scratch,
+ Compression

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Acromioclavicular Joint Sprain

assesment

grade I-VI

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acromioclavicular joint sprain

plan

Grade 1 – Ice, Protect/RTP as tolerated,
Grade 2-6 - Immobilize, ice, may need x-ray;
ROM ex progressing to proprioception &
strength; may be surgically repaired
(controversial)

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rotator cuff tendionpathy/subacromial bursitis

subjective

Muscle imbalance b/t IR & ER, *poor
scapular control, capsular laxity or secondary
due to *impingement; usually affects
supraspinatus tendon; poor vascularization
leads to inc injury and dec healing; shape of
acromion process may predispose (see Box 15-
5, p. 667)

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rotator cuff tendionpathy/subacromial bursitis

objective

Pain progressing before to during to after
activity; achy pain to begin c; + Drop Arm,
+ Empty Can, + SRT, +Scapular
Dyskinesis

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rotator cuff tendionpathy/subacromial bursitis

plan

Dec inflam c ice, US &/or NSAIDS;
allow rest in Grade 2-3; strengthen
scapular and RC muscles; correct
biomechanics prn

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subacromial impingement

subjective

Dec space under coracoacromial arch
leads to inflam of RC tendons (see p.
667, box 15-5 for acromion shape
classification), subacromial bursae &amp;/or
long head biceps tendon also inflammed;
overuse, *scapular weaknesses; c/o pain
under acromion process and may radiate
down arm

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subacromial impingement

objective

May be guarding; pt tend greater
tuberosity &amp; bicipital groove; AROM may
be limited/painful above 90 degs abd,
IR/ER, flex may be weak/painful, may
experience painful arc; + Neers, +
Hawkins-Kennedy, + Empty Can, + SRT,
\+ Scapular Dyskinesis

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subacromial impingement

plan

ce, US, NSAIDS, rest, *scapular
strengthening, *review mechanics, RC
strengthening,

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acromion shape types

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glenohumeral instabiltiy

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Can be ant, post, or multidirectional
Involves ligamentous or labral pathology,
muscular weakness or capsular instability
Severity is based on the amount of humeral
head glide/translation on the glenoid fossa

Superior Labral Pathology (SLAP Lesion)

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Tear of the Superior Labrum
Often times will avulse origin of the long head of
biceps brachii from the supraglenoid tubercle
(Type II and IV) (see Box 15-10, p. 674)
Must differentiate it from impingement. Currently,
efficacy studies being conducted to determine
which special tests are sensitive to SLAP lesions
and NOT impingement syndrome – O’Brien Test

SLAP

MOI

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Direct Blow, Traumatic dislocation, Distal Upper Extremity

Traction

SLAP

symptoms

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Popping, clicking, or catching
Weakness, stiffness, or pain while lying on the affected
shoulder
Deep pain

SLAP

physical findings

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Deep crepitus, snapping
 Biceps tenderness
 Positive Neer Test
 Positive Apprehension (39%)
 Positive Cross-over Test
 Positive Compression Test
 Positive Speeds Test
 Positive O’Brien Test

anterior instability

subjective

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laxity in the middle GH lig, ant portion of
inf GH lig &/or muscle weakness or injury
to superior and middle GH lig; Mxexcessive ER and Abd of humerus

anterior instability | objective

``` If dislocated = deformity, pain, dec ROM If chronic = Muscle atrophy may be present; pt tend ant GH jt; A/PROM dec ER; RROM weakness c ER, may be c pain; + Ant Glide, + Apprehension, + Relocation ```

anterior instability | assesment

``` Bankart Lesion – IGHL is avulsed from labrum or IGHL is avulsed with labrum; c/o pain and crepitus during GH glide testing, loading and shifting or ER Hill-Sachs Lesion – Defect in post humeral head’s articular cartilage due to relocation of the humerus ```

anterior instability | plan

Immobilize & refer to physician if dislocated; if chronic, ice, e-stim, scapular and RC strengthening, possibly brace; may require surgical intervention

posterior instability | subjective

Humerus is IR and flexed while longitudinal force is applied; may be due to repetitive forces (blocking, swimming)

posterior instability | objective

Deformity, dec ROM & general pain; if chronic, subscapularis weakness c laxity of coracohumeral and post band of IGHL; + Post Apprehension

posterior instability | assesment

may have a reverse hills sachs lesion

posterior instability

Immobilize & refer to physician if dislocated; if chronic, ice, e-stim, scapular and RC strengthening, possibly brace; may require surgical intervention

inferior instability | subjective

Location of laxity varies according to position of humerus; not always acute in nature (multi-directional)

inferior instability | objective

Atrophy of deltoids, + Sulcus

inferior instability | plan

Immobilize & refer to physician if dislocated; if chronic, ice, e-stim, scapular and RC strengthening, possibly brace; may require surgical intervention

Bicipital Tendinopathy/Subluxing BicepsTendon | subjective

``` Overuse usually long head, RC dysfxn or impingement; rupture of transverse lig creates subluxing long head (forced ER); c/o pain over greater tuberosity/bicipital groove, may radiate, feels sharp if subluxing ```

Bicipital Tendinopathy/Subluxing BicepsTendon | objective

Pt tend bicipital groove &/or coracoid process; weakness or pain c elbow flex &/or shoulder flex + Yergason’s for sublux, + Speed’s for tend., + Ludington’s for rupture

Bicipital Tendinopathy/Subluxing BicepsTendon | plan

Ice, US, &/or NSAIDS, strengthen | scapular & RC, correct biomechanics prn

Thoracic outlet syndrome | subjcetive

overdeveloped scalene muscles, cervical rib & scar tissue/callus formation around nerve roots (brachial plexus, subclavian artery & vein); achy pain across shoulder, radiating pain from neck to arm; heavy or weak feeling esp when arm is overhead (it may change color &/or temp, swell, and paresthesia may be present

TOS | objective

+ Allen, + Roos, + Adson’s, + Military | Brace

TOS | plan

limit overhead activities; strengthen scapular muscles; improve posture, limit ROM; stretching

clavicular fracture | subjective

FOOSH, fall of tip of shoulder or direct blow; usually occurs in middle third of bone

clavicular fracture | objective

Athlete carries c support of arm, head tilted toward injury, chin away; deformity, pain/pt tend, swelling

clavicular fracture | plan

immobilize and refer

scapular fracture | subjective

``` direct impact (usu high velocity) or force transmitted up through humerus ```

scapular fracture | objective

pain during mvt, swelling, pt tend

scapular fracture | plan

immobilize and refer

Exam 2 Injury Flashcards

(46 cards)