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What causes scapular winging?
Weak serratus anterior
Where can shoulder contusions occur?
- biceps - blocker's/tacklers
What is the MOI of a humerus fracture?
- rotary force on a fixed arm
Where do humerus fractures occur?
What are the complications of a humeral fracture?
- radial nerve and groove
- volkman's ischemic contracture
What are the signs and symptoms of a humeral fracture?
- Audible pop/crack
What are the MOIs for a clavicle fracture?
What are the signs and symptoms of a clavicle fracture?
- decreased ROM (except IR & ER)
- compression test
What are the signs and symptoms of a biceps tendon rupture?
- obvious deformity
- decreased strength
What are the predisposing factors for a rotator cuff tear?
- chronic impingement
- chronic tendinopathy
- repetitive throwing (eccentric mvmnt)
What are the signs and symptoms of a rotator cuff tear?
- pain on G or L tuberosity
- painful overhead motions
- AROM/PROM pain & weakness
- Atrophy if chronic
- Drop arm
- Empty can
- Lift off
What are the MOIs of a SC joint sprain?
- contact to lateral shoulder
What is sprained in a SC joint sprain?
- sternoclavicular lig
- costoclavicular lig
- interclavicular lig
What are the signs and symptoms of a SC joint sprain?
- pain w ABD, FLEX, HABD, HADD
- pain under SC joint with HADD
What is the MOI for a SC joint dislocation?
What should be ruled out in a young athlete with a SC joint dislocation?
What are the MOIs for an AC joint sprain?
- fall on elbow
- direct blow
- superior force to clavicle with a fixed scap
- overuse stress
- articular disc pathology
What are the characteristics of a Grade 1 AC sprain?
- called a shoulder pointer
- partial stretch
- mild SHARP
- no laxity/deformity
What are the characteristics of a Grade 2 AC sprain?
- partial tear AC and CC
- slight step deformity
What are the characteristics of a Grade 3 AC sprain?
- complete tear of AC and CC
- piano key sign
What are the signs and symptoms of an AC joint sprain?
- pain w AROM
- pain w PROM above 90
- decreased ROM acromion muscles
- Crossbody HADD
What are the characteristics of chronic AC joint pain?
- rotator cuff symptoms
- pain radiates into scapula and neck
- no instability
- no traumatic MOI
What are the potential causes of glenohumeral instability?
- muscular weakness
What are the static stabilizers of the GH joint?
What are the dynamic stabilizers of the GH joint?
what is the MOI for an anterior GH dislocation?
What are the signs and symptoms of an anterior GH dislocation?
- humeral head inferior to coracoid process
- sulcus sign
- shoulder loose w ER & ABD
What are the potential complications of an anterior GH joint dislocation?
- Axillary nn impingement
- Hill-Sach's Lesion
- Labral Tear
Which special tests are positive in an anterior GH joint dislocation?
- Ant drawer
- Load and Shift
What is a Hill-Sach's Lesion?
articular cartilage defect on post/lat humeral head
What is a Bankart Lesion?
an inferior GH ligament avulsion with labral involvement
What are the signs and symptoms of a Bankart Lesion?
- clicking, popping
- diffuse pain
Which special tests are positive with a Bankart Lesion?
- Anterior Slide
What is a SLAP lesion?
- superior labrum anteroposterior
- Biceps long head involvement
What are the MOIs for a SLAP lesion?
- Superior compression
- inferior traction
- throwing follow-through
- anterior dislocation
What is a Type 1 SLAP lesion?
superior labral fraying/degeneration
What is a Type 2 SLAP lesion?
- superior labrum and biceps anchor detached from superior glenoid tubercle
- most common
What is a Type 3 SLAP lesion?
- Bucket handle tear (longitudinal)
- Biceps tendon and labral rim intact
What is a Type 4 SLAP lesion?
- Bucket handle tear (longitudinal)
- tear extends to biceps tendons
What are the signs and symptoms of a SLAP lesion?
- Deep pain b/w AC and coracoid process
- locking, popping, grinding
- pain while lying on shoulder
- limited ROM
- loss of strength
Which special tests are positive with a SLAP lesion?
- Biceps Load
- Anterior slide
What are the MOIs for a posterior GH instability?
- FLEX & IR
- acute or accumulated trauma
- weak subscapularis
- reverse Hill-Sach's
What are the signs and symptoms of posterior GH instability?
- pain pushing heavy doors
- diffuse pain
- loose with HADD
- decreased IR
Which special tests are positive with Posterior GH instability?
- posterior drawer
- load and shift
What increases inferior GH instability?
Rotator cuff weakness or tears
What are the signs and symptoms of inferior GH instability?
pain with traction - carrying heavy bags
Which special tests are positive with inferior GH instability?
What is shoulder impingement?
decreased space below coroacoacromial arch and coracoacromial ligament
In shoulder impingement, which structures can be compressed between the humeral head and acromion process?
- Biceps LH
- Subacromial bursa
- GH capsule
What are the possible causes of shoulder impingement?
- coracacromial arch or acromion variation
- tight posterior capsule and ligaments
- rotator cuff fatigue or decreased strength from repetitive overhead activities
- scapular dyskinesis
What are the 3 stages of impingement?
- 1. intermittent pain w overhead activities
- 2. pain at rest or other activities, night pain, degeneration
- 3. constant pain, restricted ROM, RC tear
What are the signs and symptoms of impingement?
- pain and weakness with IR, ER, FLEX and ABD
- pain at acromion, greater tuberosity, bicipital groove
- painful arc
Which special tests are positive with impingement?
What factors contribute to tendinopathy?
- imbalance between IR and ER
- capsular laxity
- poor scapular control
- impingement syndrome
- poor vascularization
- acromion shape
- eccentric forces
What are the signs and symptoms of a rotator cuff tendinopathy?
- slow onset
- deep subacromial pain after activity that progresses to during activity, then progresses to constant
Which rotator cuff muscle is most susceptible to tendinopathy?
supraspinatus because it is the closest to the acromion
Which special tests are positive with rotator cuff tendinopathy?
What are the causes of bicipetal tendinopathy?
- Rotator cuff impingement, overuse, or dysfunction
- sprained transverse humeral ligament causing tendon subluxation
Which special tests are positive with Bicipetal tendinopathy?
Where can bursitis occur in the shoulder?
What is the cause of bursitis in the shoulder?
What are the signs and symptoms of bursitis?
- lateral pain (rebound)
- constant dull ache
- overhead activity pain
Which tests are positive with shoulder bursitis?
- empty can
Where can the suprascapular nerve become compressed?
suprascapular notch (superior border, medial to base of coracoid process)
Where can the axillary nerve become compressed?
- Quadrilateral space
- sup = teres minor and subscap
- inf = teres major
- med = long head triceps
- lat = humerus surgical neck
Where can the long thoracic nerve become compressed?
Where can the accessory nerve become compressed?
- neck posterior triangle
What are the causes of neurovascular injuries?
What are the signs and symptoms of a neurovascular injury?
- neural symptoms
- altered mechanics (scapular winging)