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Shoulder Injuries
Clavicle FxMOI: FOOSH, Fall on tip of
shoulder, direct contact
S&S: guarding, obvious deformity, swelling, point tenderness
Clavicle FxPlan: refer for x-rays, sling
and swathe, treat for shock, possible surgery
Follow up: immobilize 6-8 weeks
Acromioclavicular SprainMOI: direct contact to tip
of shoulder or FOOSH
Acromioclavicular SprainS&S: Grade 1-point tenderness,
discomfort during movement
Grade 2-partial displacement, acromial end of clavicle sticks up, ttp, unable to fully abduct, AC stress test positive
Acromioclavicular SprainS&S: Grade 3 – complete rupture
of the AC and CC ligaments, displacement, limited abduction
Grade 4 – posterior dislocation of clavicle, point tenderness, limited ROM
Acromioclavicular SprainS&S: Grade 5 – Muscle and
ligament ruptures, gross deformity, severe pain, loss of movement, shoulder instability
Grade 6 – clavicle displaced inferior to the coracoid, rare in sports
Acromioclavicular SprainPlan: 1. Cold and pressure2. Sling and Swathe3. Refer to doctor
GH DislocationsAnterior
Posterior
GH DislocationsExtensive damage to the
shoulder complex occurs.
Anterior DislocationMOI:
• Direct contact to posterior shoulder
• Forced abduction, external rotation, and extension
Anterior DislocationsS&S1. Flattened deltoid contour2. Guarding – slight abduction and external rotation3. Humeral head palpated in the axilla(armpit)4. Unable to touch opposite shoulder5. Moderate pain6. Disability
Posterior GH DislocationMOI:
• Forced adduction and internal rotation
• Fall on extended and internally rotated arm
Posterior GH DislocationsS&S:1. Severe pain and disability2. Guarding – adduction and internal rotation3. Acromion and coracoid stick out4. Head of humerus visible posterior5. Limited external rotation and elevation
GH Dislocation - PlanImmobilizationIceX-ray if first dislocationReduce shoulderIceImmobilization
GH Dislocation - PlanRehab
• Internal and External rotation are IMPORTANT
• Start with isometrics then add resistance
Bracing for play
Impingement SyndromeMOI: repetitive overhead
stressExamples:
• Swimming
• Serving a tennis ball
• Hitting volleyball (spike)
• Throwing (baseball, track, football)
Impingement SyndromeS&S:1. Diffuse pain around acromion2. Pain with overhead activities3. E.R. weaker than I.R.4. Positive impingement tests5. Empty can and drop test increase pain.
Impingement SyndromePlan:1. Restoring normal biomechanics2. Strengthen rotator cuff3. Strengthen core4. Joint Mobilizations5. RICE and e-stim6. Modify activity
Severe ImpingementPlan:Immobilization and
complete rest.Potentially need surgical
intervention
Thoracic Outlet – BasicsCompression of the
brachial plexus, subclavian artery and vein
Thoracic Outlet SyndromeMOI:1. Narrowing between 1st rib and clavicle2. Anterior and middle scalene muscles3. Pectoralis minor compressing4. Presence of a cervical rib
Thoracic Outlet SyndromeS&S:
• Paresthesia
• Pain
• Feeling cold
• Muscle weakness
• Muscle atrophy
• Radial nerve palsy
• Poor circulation in hand
Thoracic Outlet SyndromeSpecial Tests:1. Wright’s Test or Hyperabduction test2. Eden’s Test3. Roo’s Test4. Adson’s Test
Thoracic Outlet SyndromePlan: Correcting the MOI
with stretching & strengthening
1. Stretching• Pectoralis minor
• Scalenes
TOS - Plan
Strengthening• Trapezius
• Rhomboids
• Serratus Anterior
TOS - Plan
Strengthening• Trapezius
• Rhomboids
• Serratus Anterior
Strengthening• Trapezius
• Rhomboids
• Serratus Anterior
Brachial Plexus Neuropraxia
Also called a stinger or burner.
MOI: direct contact or hyper-horizontal abduction
Brachial Plexus Neuroplaxia
S&S:
• Numbness and tingling down through hand
• Pain shooting to hand
• Inability to move hand
• Pain in shoulder
Plan:Have athlete move their
arm.Give them about 15
minutes to recover. If they don’t recover, send to hospital.
Brachial Plexus Neuroplaxia
Biceps Brachii RupturesMOI:Powerful eccentric or
concentric contraction of the muscle
Can rupture at long head or insertion
“Popeye” effect
Biceps Brachii RuptureS&S:
• SNAP
• Sudden, intense pain
• Popeye effect
• Weakness of the biceps
Biceps Brachii RupturePlan:
• Cold
• Sling
• Refer to physician
• Usually surgery
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