Shoulder Pathology
Stages of Frozen Shoulder
1. Freezing 2. Frozen 3. Thawing
Types of AC Joint Seperation
1. Ligament in tack but stretched 2. AC ligament torn, paino key sign, need intervention or else dysfxn 3. AC & CC ligament torn 4. Displaced clavicle 5. Elevation of clavicle 6. Clavicle down and away --> surgical repair needed
Acromioclavicular Joint Injury
Acromioclavicular ligament Fall on outstretched arm on tip of shoulder --> depression Distal aspect of clavicle raised AC ligament + CC ligament torn
Anterior Dislocation of GH Joint
Baseball pitch Abduction and external rotation HH pushed anterior out of fossa Flat deltoid
Posterior Dislocation of GH Joint
FOOSH Fall on bent shoulder HH pushed posteriorly out of fossa
Adhesive Capsulitis
Frozen Shoulder - often initiated d/t inflammation secondary to GHJ dislocation, calcific supraspinatus tendonitis, partial tear of rotator cuff, or bicipital tendonitis - traumatic or spontaneous - painful, worse at night - restricted A/PROM - May have history of heart, lung, connective tissue, or thyroid disease
Internal Impingment
GH internal rotation deficit (GIRD) GH instability Repetitive overhead movement - high volume throw Repetitive overhead movement - occupational
Open Can/Empty Test
Test for rotator cuff pretend to open/empty can
Hawkins-Kennedy Test
Tested for shoulder impingement
Drop Arm Test
Tests for rotator cuff
MDI
multi-directional instability
Ligaments of the AC Joint
- Acromioclavicular - Coracoclavicular - Coracoaromial
Glenohumeral Joint
- Ball and socket joint - Large globular humeral head articulates with shallow glenoid cavity - deepened by the glenoid labrum
Proximal Humeral Fractures
- Common in osteoporotic elderly - usually occurs secondary to a fall on an elbow when the arm is
Peripheral Nerve Injury
- Fxs of surgical neck may injure the axillary nerve - Fxs of humeral body in region of the radial groove may injure the radial nerve - Distal humeral fxs injure the medial nerve - Fxs in region of the medial epicondyle may injure the ulnar
Proximal Humeral Fractures: Tubercle
- Often result of a fall on the acromion or FOOSH - Humerus is pulled int he direction of medial rotation by the remaining muscle attachments (especially subscapularis)
Findings for Impingement
- Painful Arc - Gradual Onset - Prior Injury - GH instability/scapular dyskinesis - Forward shoulder posture/tight pectoralis minor
Chronic Instability
- Sulcus sign - apprehensive/relocation test - load and shift - a/p glide - crank test
Shoulder Impingement
- Swelling/inflammation of structures in the subacromial space cause pain when in abduction and flexion - Several structures that can get impinged - Every time space is closed, structures are hit and compressed
Mechanism of Injury for Rotator Cuff Pathology
- Training error: improper conditioning, muscle fatigue, improper warm-up - Old Age/Previous Injury: forceful ballistic concentric, forceful concentric contraction, acceleration and deceleration - Acute: FOOSH
Chronic Overuse Injuries
- may involve multiple interrelated pathologies - often the result of repeated sub-maximal trauma - may occur d/t faulty biomechanics - damage outpaces the repair process - impingement syndrome - rotator cuff injuries - supacromial bursitis - adhesive capsulitis
Acromialclavicular Joint
- plane synovial joint - articulates with the acromion process of scapula
Stage 2 - Frozen
4 to 9 months Pain decreases but adhesions thicken Joint is stiff and ROM is limited
Stage 3 - Thawing
5 to 26 months Gradual to normal ROM Gradual decrease in pain
Stage 1 - Freezing
6 weeks to 9 months Slow progression of development Increased pain and decreased motion
Primary Subacromial Impingement
Irregulary shaped acromion Spur formation on acromion
Secondary Subacromial Impingement
Loss of humeral head depression/stabilization Poor posture, Scapular Dyskensia GH Instability
Inferior Dislocation of GH Joint
Pulling of arm Arm is stuck up d/t humerus being stuck under scapula damage to axilla or rotator cuff is probable
Most Common Fracture Site of Humerus
Surgical Neck