Exam 4

not a true joint; however, the movement of the scapula on the wall of the thoracic cage is critical to shoulder joint motion

The scapulothoracic joint

Attaches the axial skeleton to the scapula and includes the levator scapula, the trapezius, the rhomboids, and the serratus anterior and posterior Which group?

Third Group

Lasts from the first movement until the ball leaves the gloved hand Lead leg strides forward while both shoulders abduct, externally rotate, and horizontally abduct What phase?

Wind-up

what two ligaments help to maintain the position of the clavicle relative to the acromion

acromioclavicular ligament along with the coracoclavicular ligament

First two of the cervical spine are the

atlas and axis

Cervical Fracture Blow to the top of the athlete's head while in flexion is called - If the head is rotated at the time of impact, dislocation may occur along with fracture

axial loading

Bones that comprise the shoulder complex and shoulder joint are the

clavicle, scapula, and humerus

Neck must have complete range of motion(ROM) to prevent injury - Can be improved through stretching exercises and strengthening exercises that incorporate complete ROM

flexibility

Muscles of the neck offer protection from

hyperflexion, hyperextension, or rotational forces

Injuries to the cervical spine may be

life threatening

Should be performed with athlete lying prone with the spine as straight as possible Head and neck should be slightly flexed Pillow placed under hips if the athlete is suffering from low back pain

palpation

maintained by the surrounding glenohumeral ligaments that form the joint capsule and by the rotator cuff muscles

position of the glenohumeral joint

what test uses forced flexion and adduction of the humerus in the overhead position may cause impingement of soft-tissue structures between the humeral head and the coracoacromial ligament

shoulder impingement First test

what test involves horizontal adduction with forced internal rotation of the humerus that also produces impingement

shoulder impingement Second test

Complication of spondylosis, resulting in hypermobility of the vertebral segment

spondylolisthesis

what joint is extremely weak because of its bony arrangement, but it is held securely by the sternoclavicular ligament that pulls the clavicle downward and toward the sternum, in effect anchoring it

sternoclavicular joint

Apply pressure to the sacroiliac joint and may indicate problems with the sciatic nerve, sacroiliac joint, or lumbar spine

straight leg raises

Musculature on each side of the spine should also be palpated for _____________ or ______________

tenderness or guarding

Thoracic vertebrae 1 through 10 articulate with

the ribs

There is very little movement in the

thoracic vertebra

Major ligaments that connect vertebral parts

Anterior longitudinal ligament Posterior longitudinal ligament Supraspinous ligament

These three bones form the four major articulations associated with the shoulder complex:

- sternoclavicular joint - acromioclavicular joint - glenohumeral joint - scapulothoracic joint

Thoracic spine: Consists of

12 vertebrae

how many vertebrae are classified as movable/true

24

The muscles acting on the glenohumeral joint can be separated into ____ groups

3

Lumbar spine: Composed of ___ vertebrae

5

Cervical spine: Composed of

7 vertebrae

how many are classified as immovable/false

9

Lasts from maximum external rotation until ball release The humerus abducts, horizontally abducts, and internally rotates at velocities approaching 8,000 degrees per second Scapula elevates, abducts, and rotates upward

Acceleration

Care - Basic procedures - Application of cold and pressure to control local hemorrhage, stabilization of the joint by a shoulder immobilizer, and referral to a physician for definitive diagnosis and treatment - Immobilization ranges from 3 to 4 days with a grade 1 to approximately 2 weeks with a grade 3 - Aggressive rehabilitation program is required for all grades Joint mobilization, flexibility exercises, and strengthening exercises should begin immediately following the recommended period of protection Progression should be as rapid as the athlete can tolerate without increased pain or swelling

Acromioclavicular sprain

Cause of injury - Fall on outstretched arm or direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage

Acromioclavicular sprain

Care Application of ice and use of a soft cervical collar Follow-up care involves ROM exercises, isometrics that progress to full-range isotonic exercises, cold, heat, and analgesic medications

Acute Strains of the Neck and Upper Back

Cause of injury Sudden turn of the head, forced flexion, extension, or rotation

Acute Strains of the Neck and Upper Back

Signs of injury Localized pain, point tenderness, restricted motion, muscle guarding, and reluctance to move the neck in any direction

Acute Strains of the Neck and Upper Back

Causes of injury Synovial membrane lining the joint capsule is impinged or trapped between the cervical vertebrae Exposure to a cold draft of air or holding the head in an unusual position over time Signs of injury Palpable point tenderness and muscle spasm, restricted R O M, and muscle guarding

Acute Torticollis

testused for anterior glenohumeral instability • This movement should not be forced

Apprehension test

Cause of injury Significant impact or direct blow to the back Signs of injury Localized pain, muscle spasm, point tenderness, and swollen, discolored area Can cause serious injury to the kidneys

Back Contusions

Care Extreme care must be used while moving the athlete - More likely to cause spinal cord injury than a fracture if one is careless

Cervical Dislocation

Cause of injury Violent flexion and rotation of the head

Cervical Dislocation

Signs of injury (same signs as a fracture) Considerable pain, numbness, weakness, or paralysis Unilateral dislocation causes the head to be tilted toward the dislocated side with extreme muscle tightness on the elongated side

Cervical Dislocation

Care Unconscious athletes: Treated as if they have sustained a serious neck injury Cervical injury: Athletes are to be moved by trained individuals only

Cervical Fracture

Signs of injury Neck point tenderness and restricted motion, cervical muscle spasm, cervical pain and pain in the chest and extremities, numbness in the trunk and/or limbs, weakness in the trunk and/or limbs, and loss of bladder and/or bowel control

Cervical Fracture

Cause of injury Similar to a strain but a more violent motion Involves a snapping of the head Sprain of the neck produces tears in the supporting tissue of the anterior or posterior longitudinal ligaments, the interspinous ligament, or the supraspinous ligament

Cervical Sprain (Whiplash)

Management Rule out fracture, dislocation, and disk injury Use of asoft cervical collar to help reduce muscle spasm Application of ice for 48 to 72 hours Heat or cold therapy and massage may also be used Bed rest, analgesics, and anti-inflammation agents in severe cases Mechanical traction

Cervical Sprain (Whiplash)

Signs of injury Similar signs and symptoms to a strained neck, except that symptoms persist longer Tenderness over the transverse and spinous processes Pain may not be experienced initially but is always present the day after the trauma

Cervical Sprain (Whiplash)

true vertebrae are

Cervical, thoracic, and lumbar vertebrae CTL

Cause of injury - Result from a fall on the outstretched arm, a fall on the tip of the shoulder, or a direct impact - Occur primarily in the middle one-third of the clavicle

Clavicle Fracture

Care - Clavicle fracture is cared for immediately by applying a shoulder immobilizer and by treating the athlete for shock, if necessary - If X-ray examination reveals a fracture, a closed reduction should be attempted by the physician, followed by immobilization for 6 to 8 weeks with a clavicle strap

Clavicle fractures

Signs of injury - Athlete supports the arm on the injured side and tilts his or her head toward that side, with the chin turned to the opposite side - Injured clavicle may appear lower than the unaffected side

Clavicle fractures

Composed of four or more fused vertebrae Also called the tailbone

Coccyx

Hands separate and ends when maximum external rotation of the humerus has occurred Foot comes in contact with the ground

Cocking

the spine is composed of how many vertebrae?

Composed of 33 vertebrae

Lasts from ball release until maximum shoulder internal rotation The external rotators of the rotator cuff contract eccentrically to decelerate the humerus The rhomboids contract eccentrically to decelerate the scapula

Deceleration

Extend from one vertebra to another

Deep muscles Interspinalis, multifidus, rotatores, thoracis, and semispinalis cervicis

Present between each of the cervical, thoracic, and lumbar vertebrae Composed of annulus fibrosus and nucleus pulposus Act as shock absorbers for the spine

Fibrocartilaginous intervertebral discs

Consists of muscles that originate on the Scapulothoracic articulation and attach to the humerus, including the latissimus dorsi and the pectoralis major Which group?

First Group

Lasts from maximum shoulder internal rotation until the end of the motion, when there is a balanced position

Follow-through Phase

Care- Immediate application of splint or immediate support with a sling, treatment for shock, and referral to a physician - Athlete will have to be out of competition for 2 to 6 months, depending on the location and severity of injury

Fractures of the humerus

Cause of injury - Fractures of the humerus happen occasionally in sports, usually as the result of a direct blow, a dislocation, or the impact of falling onto the outstretched arm

Fractures of the humerus

Signsofinjury - Prevalent signs - Pain, inability to move the arm, swelling, point tenderness, and discoloration of the superficial tissue - X-ray is positive for fracture

Fractures of the humerus

Care immediate immobilization in a position of comfort using a sling; immediate reduction by a physician; and control of the hemorrhage by cold packs Muscle reconditioning should be initiated as soon as possible Protective sling immobilization should continue for approximately 1 week after reduction Athlete is instructed to begin a strengthening program, progressing as quickly as pain allows Protective shoulder braces may help limit shoulder motion

Glenohumeral Dislocations

Cause of injury Head of humerus is forced out of its joint capsule in an anterior direction past the glenoid labrum and then downward to rest under the coracoid process - Mechanism for an anterior dislocation is abduction, external rotation, and extension that forces the humeral head out of the glenoid cavity Arm tackle in football or rugby or abnormal forces created in executing a throw can produce a sequence of events resulting in dislocation On rare occasions, the humerus dislocates in an inferior direction

Glenohumeral Dislocations

Signs of injury Flattened deltoid contour, prominent humeral head is revealed by palpation of the axilla, arm carried in slight abduction and external rotation, and moderate to severe pain and disability

Glenohumeral Dislocations

Acromioclavicular sprain Point tenderness and discomfort during movement at the junction between the acromion process and the outer end of the clavicle what grade of injury?

Grade 1

Sternoclavicular joint sprain Little pain and disability what grade of pain?

Grade 1

Acromioclavicular sprain Tearing or rupture of the acromioclavicular ligament and associated stretching of the coracoacromial ligament what grade of injury?

Grade 2

Sternoclavicular joint sprain Subluxation of the sternoclavicular joint with visible deformity, pain, swelling, point tenderness, and an inability to abduct the shoulder through a full range of motion or to bring the arm across the chest, indicating disruption of the stabilizing ligaments what grade of pain?

Grade 2

Acromioclavicular sprain Involves rupture of the acromioclavicular and coracoclavicular ligaments with dislocation of the clavicle what grade of injury?

Grade 3

Sternoclavicular joint sprain Severe, presents a picture of complete dislocation with gross displacement of the clavicle at its sternal junction, swelling, and disability, indicating complete rupture of the sternoclavicular ligament what grade of pain?

Grade 3

Stabilize the transverse and spinous processes that extend between adjacent vertebrae

Interspinous and supraspinous ligaments

Connects the laminae of adjacent vertebrae from the axis to the sacrum

Ligamentum flavum

Superficial muscles, or erector spinae Group of paired muscles:

Longissimus group iliocostalis group and spinalis group LiS

Care Cold packs and/or ice massage should be used to decrease muscle guarding Elastic wrap or an abdominal support corset-type brace helps compress the area Graduated program of stretching and strengthening during the acute stage Complete bed rest may be necessary in severe cases

Low Back Muscle Strain

Causes of injury Sudden extension in combination with trunk rotation Chronic strain associated with faulty posture Signs of injury Discomfort in the low back that is diffused or localized Pain present on active extension and with passive flexion

Low Back Muscle Strain

Care Application of ice Strengthening exercises for abdominals and back extensors Stretching in all directions Abdominal braces should be worn to provide support Will require time for healing

Lumbar Sprains

Cause of injury Bending forward and twisting while lifting or moving an object Signs of injury Localized pain lateral to the spinous process Pain becomes sharper with certain movements or postures

Lumbar Sprains

Care If symptoms and signs associated with a fracture are present, the injured athlete should be X-rayed Transporting and moving the athlete should be done on a spine board

Lumbar Vertebrae Fracture and Dislocatio

Causes of injury Trunk hyperflexion Falling from a height and landing on the feet or buttocks Fractures of the transverse or spinous processes are generally the result of a direct blow Dislocations are rare and occur only when there is an associated fracture Signs of injury Compression fractures will require X-rays for detection Point tenderness over the affected area Fractures of the transverse and spinous processes may be directly palpable Localized swelling and muscle guarding

Lumbar Vertebrae Fracture and Dislocation

Support the lower back Largest and thickest of the vertebrae

Lumbar spine

Care POLICE can be used for modulation of pain Progressive strengthening exercises of the rotator cuff muscles Frequency and level of activity should be reduced initially, with a gradual and progressive increase in intensity

Rotator Cuff Strains

Cause of injury Most common rotator cuff tendon strain involves the supraspinatus muscle, although any of the rotator cuff tendons are subject to injury Primary mechanism - Involves dynamic rotation of the arm at a high velocity, as occurs during overhead throwing or any other activity in which there is rotation of the humerus Most rotator cuff tears occur in the supraspinatus in individuals with a long history of shoulder impingement or instability and are relatively uncommon in athletes under the age of 40

Rotator Cuff Strains

Signs of injury Rotator cuff strains present pain with muscle contraction, some tenderness on palpation, and loss of strength because of pain Pain, loss of function, swelling, and point tenderness With complete tear of the supraspinatus tendon, both the impingement tests and the empty can test are positive

Rotator Cuff Strains

Used to identify problems in the sacroiliac joint

Sacroiliac compression and distraction tests

Maintained by the extremely strong dorsal sacral ligaments

Sacroiliac joint

Maintain the position of the sacrum relative to the ischium

Sacrotuberous and sacrospinous ligaments

Composed of five fused vertebrae that, along with the hip bones, form the pelvis Associated with transmission of bodyweight while sitting and standing

Sacrum

false vertebrae are the

Sacrum and coccyx

Originates on the Scapula and attaches to the humerus, including the deltoid, the teres major, the coracobrachialis, and the rotator cuff (subscapularis, supraspinatus, infraspinatus, and teres minor) Which group?

Second Group

Care Restore normal biomechanics POLICE can be used to modulate pain initially Strengthening of rotator cuff muscles and those muscles that produce movement of the scapula Stretching of the posterior and inferior joint capsule Activity that caused the problem in the first place should be modified so that the athlete has initial control over the frequency and the level of the activity, with a gradual and progressive increase in intensity

Shoulder Impingement Syndrome

Cause of injury Mechanical compression of supraspinatus tendon, the subacromial bursa, and long head of the biceps tendon, all of which are located under the coracoacromial arch Repetitive compression eventually leads to irritation and inflammation of these structures

Shoulder Impingement Syndrome

Signs of injury Diffuse pain around the acromion whenever the arm is in an overhead position Decreased strength of external rotators compared to internal rotators; tightness in the posterior and inferior joint capsule There usually is a positive impingement test, and the empty can test may increase pain

Shoulder Impingement Syndrome

Degeneration of the vertebrae is called

Spondylolysis

Care Bracing and occasional bed rest for 1 to 3 days will help reduce pain Major focus should be on exercises that control or stabilize the hypermobile lumbar segment Progressive trunk-stabilization strengthening exercises should be incorporated Braces can also be helpful during high-level activities Avoiding vigorous activity might be necessary

Spondylolysis and Spondylolisthesis

Signs of condition Persistent pain or stiffness across the low back - Pain increases after physical activity Frequent need to change position or "pop" the back to reduce pain Tenderness localized to one segment

Spondylolysis and Spondylolisthesis

Care - POLICE should be used immediately, followed by immobilization - Immobilization for 3 to 5 weeks followed by graded reconditioning exercises - High incidence of recurrence of sternoclavicular sprains

Sternoclavicular joint sprain

Cause of injury - Indirect force transmitted through the humerus, the shoulder joint, and the clavicle, or a direct impact to the clavicle

Sternoclavicular joint sprain

Cause of injury - Indirect force transmitted through the humerus, the shoulder joint, and the clavicle, or a direct impact to the clavicle

Sternoclavicular joint sprain

Muscles that flex the spine

Sternocleidomastoid muscle and abdominal muscles

Care Cold packs and anti-inflammatory medications to reduce inflammation Correct impingement mechanism that precipitates bursitis Maintain full R O M so that muscle contractures and adhesions do not immobilize the joint

Subacromial Bursitis

Cause of injury Shoulder joint is subject to chronic inflammatory conditions resulting from trauma or overuse May develop from a direct impact, a fall on the tip of the shoulder, or as a result of shoulder impingement Most often inflamed bursa

Subacromial Bursitis

Signs of injury Pain when trying to move the shoulder, especially in abduction or with flexion, adduction, and internal rotation

Subacromial Bursitis

Extend from the vertebrae to ribs

Superficial muscles, or erector spinae

Pressure is applied to the tip of the shoulder, which compresses the acromioclavicular joint and may also increase pain this test is?

Test for acromioclavicular stability

With the patient sitting, pressure is applied anteriorly, then superiorly, and then inferiorly to the proximal clavicle to determine any instability or increased pain associated with a sprain this test is?

Test for sternoclavicular joint instability

Athlete brings both arms into 90 degrees of forward flexion and 30 degrees of horizontal adduction - Weakness and pain can be detected as well as comparative strength between the two arms - Downward pressure is applied this test is?

Test for supraspinatus muscle weakness