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Management of Sports Injuries > Shoulder > Flashcards

Shoulder Flashcards

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1
Q

What is a shoulder separation and its mechanism of injury?

A

It is a sprain of the AC joint

mechanism of injury = a fall onto point of shoulder with the arm adducted (FOOSH), which drives acromion/scapula downward

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2
Q

What other injuries may occur along with a shoulder separation/AC joint sprain?

A

Associated glenohumeral injuries (i.e. SLAP lesion)

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3
Q

What provides anteroposterior and superior-inferior stability in the AC joint?

A

anteroposterior stability = capsule and acromioclavicular ligaments

superior-inferior stability = coracoclavicular ligaments

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4
Q

What can diagnose/determine a shoulder separation? (4)

A

(1) history/mechanism of injury
(2) local tenderness (i.e. AC tenderness or Paxinos Test)
(3) abduction and horizontal adduction may be painful (they load the joint)
(4) degree of deformity at AC joint

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5
Q

What are the features/presentation of an AC sprain grade 1? (5)

A

(1) minimal structure damage
(2) sprain of AC ligament
(3) locally tender
(4) no displacement
(5) full ROM

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6
Q

What treatments would you use for an AC sprain grade 1?

A

pain relief/sling, early shoulder ROM, and strengthening (i.e. trapezius, deltoid, rotator cuff, and scapular muscles)

Return to sports as tolerated and with normal ROM/strength

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7
Q

What are the features/presentation of an AC sprain grade 2? (7)

A

(1) subluxation of AC joint
(2) sprain of coracoclavicular and AC ligaments
(3) deltoid and trapezius muscles may be affected
(4) structural weakness
(5) detectable instability with stress testing (i.e. paxinos test and piano key)
(6) may have palpable step deformity
(7) initial swelling with later ecchymosis

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8
Q

What treatment/management would you use for an AC sprain grade 2?

A

Sling with modalities for pain relief, progressive ROM and strengthening that’s pain free, return to sport in 3 weeks (structural healing time = 6 weeks)

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9
Q

What are the features/presentation of an AC sprain grade 3? (5)

A

(1) dislocation of the AC joint
(2) complete disruption of the AC capsule
(3) 3rd degree sprain of AC and CC ligaments
(4) deltoid and trapezius muscles torn form distal end of clavicle
(5) obvious step deformity

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10
Q

How is an AC sprain grade 3 managed and treated?

A

Either non-operative (most favor this…deformity remains but has normal function) or surgery (stabilization to coracoid)

Treat the same as grade 2 with return to sport at 6 weeks

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11
Q

What is a SICK scapula?

A

Scapular malposition

Inferior medial border prominence

Coracoid pain and malposition

and disKineses of scapular movement

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12
Q

What is scapular dyskinesis?

A

It’s the alteration of the normal position or motion of the scapula

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13
Q

What are the symptoms of a SICK scapula? (3)

A

(1) anterior shoulder pain
(2) posterior/superior scapular pain
(3) superior AC pain

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14
Q

What are burners and stingers? What is their mechanism of injury?

A

They are nerve injuries resulting from trauma to the neck and shoulder region

mechanism of injury = shoulder depression and cervical side flexion from a direct blow

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15
Q

What are the symptoms of a burner/stinger? What portion of the brachial plexus is most invovled?

A

Symptoms = transient weakness of shoulder musculature/UE paresthesia

Brachial Plexus involvement = upper trunk (C5-C6)

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16
Q

What are the basic classifications of GH dislocations? (2)

A

(1) traumatic vs. atraumatic
(2) acute vs. recurrent

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17
Q

What is the most common type of GH instability and is it most common in traumatic or atraumatic dislocations?

A

Anterior instability = most common type

95% of traumatic dislocations are anterior dislocations

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18
Q

What provides stability to the GH joint? (5)

A

(1) joint geometry
(2) capsule/ligaments
(3) negative intra-articular forces
(4) dynamic compressive forces/neuromuscular control
(5) passive and active restraints

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19
Q

In what positions (abducted or adducted) do the superior and inferior capsular structures of the glenohumeral ligament provide stabilization?

A

inferior capsular structures = abducted positions

superior capsular structures = adducted positions

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20
Q

With anterior instability, which aspects of the capsule will be injured? What concept is this?

A

Both the anterior and posterior aspects of the capsule will be injured

This is the circle concept

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21
Q

What are the 2 mechanisms of injury for an anterior dislocation?

A

(1) excessive forces which push the arm into abduction, external rotation, and extension
(2) direct blow to posterior shoulder, forcing the humerus out in an anterior-inferior direction adjacent to the coracoid process

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22
Q

What injury may occur with an anterior dislocation that occurs in an anterior-inferior direction?

A

A Bankart Lesion (anteroinferior glenoid labrum avulsion)

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23
Q

What’s the mechanism of injury for a posterior dislocation? (2)

A

(1) blow to anterior shoulder
(2) fall on outstretched arm that is flexed, adducted, and IR

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24
Q

In what type of dislocation does spontaneous reduction typically occur? Why?

A

Posterior dislocation because the muscle tension of the rotator cuff muscles reduces the humeral head

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25
What is the presentation of an anterior GH joint dislocation?
intense pain, apprehension, possible tingling and numbness down the arm, and abnormal contours of the shoulder
26
What is important to include during an exam of an individual with an anterior GH joint dislocation? (3)
(1) sensation (axillary nerve or musculocutaneous and median nerves) (2) strength (may be difficult to assess due to pain) (3) peripheral circulation
27
What is a bankart lesion?
lesion involving the anterior capsule, labrum, and glenoid rim
28
What does a bankart lesion predispose the shoulder to? Why?
Recurrent dislocations because an intact labrum is important for maintaining negative inter-articular pressure
29
What is a bony bankart?
A lesion involving the labrum and a glenoid fracture
30
What's a Hill-Sachs lesion?
A defect in the articular surface of the posterior humeral head
31
What other injuries can occur along with an anterior GH joint dislocation? (5)
(1) Bankart lesion or Bony Bankart (2) Hill-Sachs lesion (3) Nerve and vascular damage (4) rotator cuff tear (5) fracture
32
What factors determined treatment/prognosis for GH joint dislocations? (5)
(1) frequency (acute, chronic, recurrent) (2) causes (traumatic, atraumatic, acquired) (3) direction of instability (4) degree (subluxation or dislocation) (5) functional needs and age
33
What group of individuals has the highest recurrence rate of GH joint dislocations?
Athletes under 20 years old (recurrence rate as high as 80%)
34
What does TUBS and AMBRI stand for?
TUBS (torn loose)= traumatic, unilateral/unidirectional, bankart lesion, and surgery is treatment of choice AMBRI (born loose) = atraumatic, multidirectional, bilateral, rehabilitation, inferior capsular shift if rehab fails
35
What is surgically repaired for a Bankart lesion?
The labral-capsular complex is repaired anatomically and may not be necessary to shift or tighten the capsule
36
What is surgically repaired for anterior instability without significant labral injury?
The capsule and glenohumeral ligaments are tightened with arthroscopic plication or capsular shift (addressing the permanent plastic deformation)
37
What is Phase 1 (postoperative weeks 0-6) of ASSET's guidelines for arthroscopic anterior capsulolabral repair?
Focus = protect surgical repair and achieve, but don't exceed, stage ROM goals *minimize repetitive loads to protect healing tissue and suture anchors* AROM and PROM allowed given intact rotator cuff, but not forced
38
What is Phase 2 (postoperative weeks 6-12) of ASSET's guidelines for arthroscopic anterior capsulolabral repair?
Focus = continued patient education on activity limitations, staged ROM goals, and initiation of rotator cuff and scapular neuromuscular control activities Goal = full ROM at 12 weeks
39
What is Phase 3 of ASSET's guidelines for arthroscopic anterior capsulolabral repair?
Focus = normalizing neuromuscular function with strengthening, endurance, power, and dynamic stability exercises Goal = maximize the patient's ability to return to full ADLs, work, and recreational activities
40
What is the “thrower's paradox”?
This is when the shoulder is mobile enough to reach extreme positions of rotation, while remaining stable so the humeral head can remain in the glenoid socket, creating a stable fulcrum for rotation
41
What are some anatomical adaptations found in the throwing athlete? (2)
(1) bony and soft tissue changes (2) arc of motion (ER and IR) is typically 180 degrees with a posterior shift (i.e. increased ER and decreased IR with shoulder abducted)
42
What can GIRD lead to and why?
Leads to SLAP lesions and articular sided cuff tears because of posterior capsule tightness and excessive ER placing increased stress on the biceps anchor and further laxity of anterior aspect of the capsule
43
What is a clinical finding of GIRD and how is it treated?
Loss of IR \>25 degrees compared to non-throwing side Treatment = stretching of posterior capsule
44
What is “throwers laxity”?
It is laxity of the anterior and inferior GH joint capsule
45
What is the optimum ER:IR strength?
66%:75% for ER:IR
46
What should be evaluated in the throwing athlete?
ROM, strength, laxity, proprioception, athletes throwing program, exercise program, throwing mechanics
47
What are the goals for Phase 1 of the “nonoperative rehab for the throwing athlete”?
improve flexibility, establish dynamic stability, normalize muscle balance, restore proprioception (neuromuscular control)
48
What are the goals for Phase 2 of the “nonoperative rehab for the throwing athlete”?
progress the strengthening program, continue to improve flexibility, and facilitate neuromuscular control
49
What are the goals for Phase 3 of the “nonoperative rehab for the throwing athlete”?
initiate aggressive strengthening, enhance power and endurance, add functional drills, and initiate throwing
50
What are the goals for Phase 4 of the “nonoperative rehab for the throwing athlete”?
return to throw by progressing interval throwing program
51
What are the types of rotator cuff impingement? (2)
(1) External: primary or secondary (2) Internal/Posterior
52
What is primary impingement?
impingement from structural narrowing (i.e. osteophytes or acromion shape)
53
What are the types of acromion shapes?
Flat, Curved, and Hooked
54
What is secondary impingement?
results from pre-existing shoulder instability, diminished dynamic stabilization from rotator cuff due to fatigue, overload, or injury, or a SICK scapula
55
What is “Swimmer's Shoulder”?
Painful arc syndrome caused by impingement of supraspinatus and biceps tendons against coracoacromial arch
56
What is Internal (Posterior) Impingement?
Can occur physiologically or pathologically in overhead athletes due to repetitive trauma during cocking phase of throwing
57
What is impinged during posterior impingement?
The supraspinatus and infraspinatus impinge between the greater tuberosity of humeral head and posterosuperior glenoid
58
What does anterior laxity cause in the athlete?
Posterior impingement due to anterior migration of the humeral head in abducted and ER positions
59
How can you tell the difference between rotator cuff pathology and internal impingement?
rotator cuff pathology = pain noted during deceleration phase internal impingement = pain in late cocking and early acceleration
60
What happens to the tendons in a rotator cuff tendinopathy?
The tendons become swollen and hyercellular, collagen matrix is disorganized, and the tendon is weaker
61
What are the 6 principles of tendinopathy treatment?
1) *Identify and modify negative external forces / factors (i.e. swimming – change stroke mechanics)* 2) *Establish a stable baseline for treatment (i.e.* Symptoms should be stable and predictable) 3) *Determine the tensile load starting point* 4) *Progress load according to symptoms (i.e.* A stimulus for adaptation is required) 5) *Control Pain* 6) *Address entire Kinetic Chain (i.e.* Malfunction in one segment may increase stress in other segments)
62
What is a SLAP Lesion?
A tear of the superior labrum that extends form anterior to the biceps to posterior to the biceps
63
Describe the 4 types of SLAP Lesions.
I. Fraying and degeneration II. Detachment of the long head of the biceps and superior labrum from glenoid rim (surgery required) III. Superior labrum is torn and displaced into joint (bucket handle). Biceps and its labral attachment still intact. IV. Tear extends into the long head tendon, with part of the tendon displaced into joint along with the superior labrum (surgery required)
64
What is the mechanism of injury for a SLAP Lesion? (2)
(1) traction (especially for overhead athletes) (2) compression injuries (i.e. FOOSH injuries)
65
What are the treatment options for the various SLAP Lesions?
Unstable lesions (II and IV) are repaired arthroscopically. Stable lesions (I and III) may require arthroscopic debridement to eliminate the mechanical irritation. PT = Dynamic stabilization exercises for the glenohumeral joint for stable lesions and also post-operative rehabilitation
66
What are 10 principles of rehabilitation in the thrower?
* Never overstress healing tissue * Prevent negative effects of immobilization * Emphasize external rotation muscular strength * Establish muscular base * Emphasize scapular muscle strength * Improve posterior shoulder flexibility (IR ROM) * Enhance proprioception and neuromuscular control * Establish biomechanically efficient throwing * Gradually return to throwing activities * Used established criteria to progress

Management of Sports Injuries (5 decks)

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